Provider Demographics
NPI:1144743725
Name:EGHTESAD, DEBORAH (MS, LPC)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:EGHTESAD
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:HAGGARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11911 S REDBUD ST
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-4384
Mailing Address - Country:US
Mailing Address - Phone:417-260-1980
Mailing Address - Fax:479-750-4843
Practice Address - Street 1:7320 S YALE AVE STE B
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-7034
Practice Address - Country:US
Practice Address - Phone:918-992-2335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-25
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 101YM0800X
OK10472101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health