Basic Information
| Provider Information | |||||||||
| NPI: | 1396975983 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DANIEL | ||||||||
| FirstName: | RITA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPC, NCC, LADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7709 NW CHESLEY DR | ||||||||
| Address2: | |||||||||
| City: | LAWTON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 735054153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5802843911 | ||||||||
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| Practice Location | |||||||||
| Address1: | 807 SW F AVE | ||||||||
| Address2: | |||||||||
| City: | LAWTON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 735014506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5805957000 | ||||||||
| FaxNumber: | 5805957005 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2009 | ||||||||
| LastUpdateDate: | 03/10/2010 | ||||||||
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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 | 101YP2500X | 3153 | OK | Y | Behavioral Health & Social Service Providers | Counselor | Professional | 101YA0400X | 483 | OK | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 100747400B | 05 | OK | MEDICAID |