Provider Demographics
NPI:1174898852
Name:LUGRAND, DOMONIQUE MONTRELL
Entity type:Individual
Prefix:MS
First Name:DOMONIQUE
Middle Name:MONTRELL
Last Name:LUGRAND
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 1:2504 FOUR OCLOCK DRIVE
Mailing Address - Street 2:
Mailing Address - City:OKC
Mailing Address - State:OK
Mailing Address - Zip Code:73128
Mailing Address - Country:US
Mailing Address - Phone:405-664-0415
Mailing Address - Fax:
Practice Address - Street 1:2504 FOUR OCLOCK DRIVE
Practice Address - Street 2:
Practice Address - City:OKC
Practice Address - State:OK
Practice Address - Zip Code:73128
Practice Address - Country:US
Practice Address - Phone:405-664-0415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-14
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7592101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional