Provider Demographics
NPI:1083657274
Name:THORSON, DARLINE (PHD)
Entity Type:Individual
Prefix:
First Name:DARLINE
Middle Name:
Last Name:THORSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 721591
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-8222
Mailing Address - Country:US
Mailing Address - Phone:405-243-6770
Mailing Address - Fax:405-290-1450
Practice Address - Street 1:1800 N INTERSTATE DR STE 111
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-2995
Practice Address - Country:US
Practice Address - Phone:405-290-1411
Practice Address - Fax:405-290-1450
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK964103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200022290Medicaid
OKOK100311Medicare PIN