Provider Demographics
NPI:1245504430
Name:PHARES, ODETE CARNEIRO (MS/HR)
Entity type:Individual
Prefix:
First Name:ODETE
Middle Name:CARNEIRO
Last Name:PHARES
Suffix:
Gender:F
Credentials:MS/HR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22183 COUNTY ROAD 3 DR
Mailing Address - Street 2:
Mailing Address - City:STONEWALL
Mailing Address - State:OK
Mailing Address - Zip Code:74871-2021
Mailing Address - Country:US
Mailing Address - Phone:580-265-4649
Mailing Address - Fax:
Practice Address - Street 1:22183 COUNTY ROAD 3 DR
Practice Address - Street 2:
Practice Address - City:STONEWALL
Practice Address - State:OK
Practice Address - Zip Code:74871-2021
Practice Address - Country:US
Practice Address - Phone:580-265-4649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health