Basic Information
| Provider Information | |||||||||
| NPI: | 1255459889 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DENISE LAGRAND, PSY.D., LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1247 | ||||||||
| Address2: | |||||||||
| City: | TAHLEQUAH | ||||||||
| State: | OK | ||||||||
| PostalCode: | 744651247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9189319600 | ||||||||
| FaxNumber: | 9184568773 | ||||||||
| Practice Location | |||||||||
| Address1: | 411 W CHICKASAW ST | ||||||||
| Address2: | |||||||||
| City: | TAHLEQUAH | ||||||||
| State: | OK | ||||||||
| PostalCode: | 744644301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9189319600 | ||||||||
| FaxNumber: | 9184568773 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LAGRAND | ||||||||
| AuthorizedOfficialFirstName: | DENISE | ||||||||
| AuthorizedOfficialMiddleName: | MICHELE | ||||||||
| AuthorizedOfficialTitleorPosition: | SOLE PROPRIETOR | ||||||||
| AuthorizedOfficialTelephone: | 9189319600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PSY.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 04-1P | AR | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC0700X | 533 | AK | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC0700X | 727 | OK | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.