Provider Demographics
NPI:1235341389
Name:DAFFORN, THOMAS ALAN (PHD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ALAN
Last Name:DAFFORN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4870 S LEWIS AVENUE
Mailing Address - Street 2:SUITE 180
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-5141
Mailing Address - Country:US
Mailing Address - Phone:918-477-2649
Mailing Address - Fax:918-524-1480
Practice Address - Street 1:4870 S LEWIS AVENUE
Practice Address - Street 2:SUITE 180
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-5141
Practice Address - Country:US
Practice Address - Phone:918-477-2649
Practice Address - Fax:918-524-1480
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK613103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist