Provider Demographics
NPI:1720287428
Name:RIDEAU, DEANDRIA ELAINE (PSYCHOTHERAPIST)
Entity type:Individual
Prefix:MS
First Name:DEANDRIA
Middle Name:ELAINE
Last Name:RIDEAU
Suffix:
Gender:F
Credentials:PSYCHOTHERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2701 N OKLAHOMA AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105-2724
Mailing Address - Country:US
Mailing Address - Phone:405-528-8686
Mailing Address - Fax:405-528-8692
Practice Address - Street 1:810 TURTLE CREEK DR
Practice Address - Street 2:
Practice Address - City:CHOCTAW
Practice Address - State:OK
Practice Address - Zip Code:73020-7433
Practice Address - Country:US
Practice Address - Phone:405-848-5620
Practice Address - Fax:405-848-5619
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100742400FMedicaid
OK100742400BMedicaid
OK100742400DMedicaid