Provider Demographics
NPI:1174961130
Name:MAYS, DESAREA ANTWANETT
Entity type:Individual
Prefix:
First Name:DESAREA
Middle Name:ANTWANETT
Last Name:MAYS
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 1:2600 TEALWOOD DR APT 1024
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-1784
Mailing Address - Country:US
Mailing Address - Phone:405-875-1526
Mailing Address - Fax:
Practice Address - Street 1:2600 TEALWOOD DR APT 1024
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-1784
Practice Address - Country:US
Practice Address - Phone:405-875-1526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst