Provider Demographics
NPI:1396975983
Name:DANIEL, RITA (LPC, NCC, LADC)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:DANIEL
Suffix:
Gender:F
Credentials:LPC, NCC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7709 NW CHESLEY DR
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-4153
Mailing Address - Country:US
Mailing Address - Phone:580-284-3911
Mailing Address - Fax:
Practice Address - Street 1:807 SW F AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-4506
Practice Address - Country:US
Practice Address - Phone:580-595-7000
Practice Address - Fax:580-595-7005
Is Sole Proprietor?:No
Enumeration Date:2009-07-17
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3153101YP2500X
OK483101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100747400BMedicaid