Individual
DEANNA CARRASCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11428 E 20TH ST, UNIT A, TULSA, OK 74128-6451
(845) 321-2049
Mailing address
3901 S WALNUT AVE, BROKEN ARROW, OK 74011-1635
(918) 872-8435
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000000000
—
OK
Enumeration date
08/15/2012
Last updated
08/15/2012
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