Provider Demographics
NPI:1902992522
Name:MCFADDEN, LATRITA MARIE (BS)
Entity Type:Individual
Prefix:
First Name:LATRITA
Middle Name:MARIE
Last Name:MCFADDEN
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:LATRITA
Other - Middle Name:MARIE
Other - Last Name:BRADFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9904 GEORGIA AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-4029
Mailing Address - Country:US
Mailing Address - Phone:918-304-9853
Mailing Address - Fax:406-463-5755
Practice Address - Street 1:9904 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-4029
Practice Address - Country:US
Practice Address - Phone:918-304-9853
Practice Address - Fax:406-463-5755
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100734620DMedicaid
OK100734620BMedicaid