Provider Demographics
NPI:1447501556
Name:LOLLES, DEVIN
Entity type:Individual
Prefix:
First Name:DEVIN
Middle Name:
Last Name:LOLLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 NW 124TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-5063
Mailing Address - Country:US
Mailing Address - Phone:405-664-4104
Mailing Address - Fax:
Practice Address - Street 1:1525 NW 124TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-5063
Practice Address - Country:US
Practice Address - Phone:405-664-4104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional