Basic Information
| Provider Information | |||||||||
| NPI: | 1326386079 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HABEKOTT | ||||||||
| FirstName: | DESTINY | ||||||||
| MiddleName: | RENAE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 202639 E COUNTY ROAD 42 | ||||||||
| Address2: | |||||||||
| City: | WOODWARD | ||||||||
| State: | OK | ||||||||
| PostalCode: | 738015442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5802545322 | ||||||||
| FaxNumber: | 5802545335 | ||||||||
| Practice Location | |||||||||
| Address1: | 202639 E COUNTY ROAD 42 | ||||||||
| Address2: | |||||||||
| City: | WOODWARD | ||||||||
| State: | OK | ||||||||
| PostalCode: | 738015442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5802545322 | ||||||||
| FaxNumber: | 5802545335 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2013 | ||||||||
| LastUpdateDate: | 01/30/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.