Provider Demographics
NPI:1447546890
Name:LOYLESS, ROXANNE (MED)
Entity type:Individual
Prefix:
First Name:ROXANNE
Middle Name:
Last Name:LOYLESS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 363
Mailing Address - Street 2:
Mailing Address - City:CALVIN
Mailing Address - State:OK
Mailing Address - Zip Code:74531-0363
Mailing Address - Country:US
Mailing Address - Phone:918-939-8304
Mailing Address - Fax:
Practice Address - Street 1:8087 E 134 RD
Practice Address - Street 2:
Practice Address - City:HOLDENVILLE
Practice Address - State:OK
Practice Address - Zip Code:74848-6237
Practice Address - Country:US
Practice Address - Phone:918-939-8304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health