Provider Demographics
NPI:1225258999
Name:MCKINNON, DOROTHY (MSW, LCSW, LADC)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:MCKINNON
Suffix:
Gender:F
Credentials:MSW, LCSW, LADC
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:
Other - Last Name:METCALF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW LADC
Mailing Address - Street 1:PO BOX 1030
Mailing Address - Street 2:
Mailing Address - City:ANTLERS
Mailing Address - State:OK
Mailing Address - Zip Code:74523-1030
Mailing Address - Country:US
Mailing Address - Phone:580-298-2830
Mailing Address - Fax:
Practice Address - Street 1:107 S HIGH ST
Practice Address - Street 2:
Practice Address - City:ANTLERS
Practice Address - State:OK
Practice Address - Zip Code:74523-3818
Practice Address - Country:US
Practice Address - Phone:580-298-2830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK30361041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200366040AMedicaid