Provider Demographics
NPI:1235250184
Name:DICKENSON-ORTEGA, JOHNNA M (LPC)
Entity Type:Individual
Prefix:MS
First Name:JOHNNA
Middle Name:M
Last Name:DICKENSON-ORTEGA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 E 45TH ST
Mailing Address - Street 2:16 E
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-1499
Mailing Address - Country:US
Mailing Address - Phone:405-788-7283
Mailing Address - Fax:405-942-5603
Practice Address - Street 1:1209 SOVEREIGN ROW
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73108-1824
Practice Address - Country:US
Practice Address - Phone:405-942-5570
Practice Address - Fax:405-942-5603
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional