Provider Demographics
NPI:1972862985
Name:ISRAEL, PALLU AD'INO (BS)
Entity type:Individual
Prefix:MR
First Name:PALLU
Middle Name:AD'INO
Last Name:ISRAEL
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:QUANTON
Other - Middle Name:D
Other - Last Name:WARE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12213 ANGELES WAY
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-1706
Mailing Address - Country:US
Mailing Address - Phone:405-414-5394
Mailing Address - Fax:
Practice Address - Street 1:8321 NE 33RD ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:OK
Practice Address - Zip Code:73084-3103
Practice Address - Country:US
Practice Address - Phone:405-414-5394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-10
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor