Provider Demographics
NPI:1861728396
Name:MARTEL, ADELENE CHEATHAM (LPC-OK 5589)
Entity type:Individual
Prefix:MRS
First Name:ADELENE
Middle Name:CHEATHAM
Last Name:MARTEL
Suffix:
Gender:F
Credentials:LPC-OK 5589
Other - Prefix:MRS
Other - First Name:ADELENE
Other - Middle Name:MARTEL
Other - Last Name:CHEATHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1213 E. JACKSON STREET
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:OK
Mailing Address - Zip Code:74743-0000
Mailing Address - Country:US
Mailing Address - Phone:580-326-7400
Mailing Address - Fax:580-326-6211
Practice Address - Street 1:1213 E. JACKSON STREET
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:OK
Practice Address - Zip Code:74743-0000
Practice Address - Country:US
Practice Address - Phone:580-326-7400
Practice Address - Fax:580-326-6211
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-18
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5589101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health