Provider Demographics
NPI:1265950299
Name:ECHOLS, DAELA (CASE MANAGER)
Entity type:Individual
Prefix:
First Name:DAELA
Middle Name:
Last Name:ECHOLS
Suffix:
Gender:F
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 LOCUST RD
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:OK
Mailing Address - Zip Code:73463-7236
Mailing Address - Country:US
Mailing Address - Phone:580-229-5609
Mailing Address - Fax:
Practice Address - Street 1:2530 S COMMERCE ST
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-5519
Practice Address - Country:US
Practice Address - Phone:580-319-7305
Practice Address - Fax:580-319-7328
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-30
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100728830Medicaid