Basic Information
| Provider Information | |||||||||
| NPI: | 1801082540 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DODSON | ||||||||
| FirstName: | DARRICK | ||||||||
| MiddleName: | DEWAYNE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 804 | ||||||||
| Address2: | |||||||||
| City: | SALINA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184342349 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 231 E GRAHAM | ||||||||
| Address2: | |||||||||
| City: | PRYOR | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9188251405 | ||||||||
| FaxNumber: | 9188251406 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2007 | ||||||||
| LastUpdateDate: | 09/17/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.