Doctor Name: | LARA DUKE |
NPI Number: | 1124369012 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 1075 |
Business Practice Address: | 610 S Hiawatha St Sapulpa, OK - 740664650 |
Business Phone Number: | 9182485026 |
Business Fax Number: | |
Mailing Address: | 610 S Hiawatha St, SAPULPA |
State: | OK |
Postal Code: | 740664650 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 03/03/2013 |
NPI Last Update Date: | 03/03/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 1075 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |