Provider Demographics
NPI:1255657854
Name:DAILEY, JOHN HENRY JR (BACHELORS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:HENRY
Last Name:DAILEY
Suffix:JR
Gender:M
Credentials:BACHELORS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 HERITAGE PLACE DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-4539
Mailing Address - Country:US
Mailing Address - Phone:405-414-1088
Mailing Address - Fax:
Practice Address - Street 1:4000 HERITAGE PLACE DR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-4539
Practice Address - Country:US
Practice Address - Phone:405-414-1088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKM081684560101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor