Provider Demographics
NPI:1437361847
Name:PINSON, DENA (PHD)
Entity Type:Individual
Prefix:DR
First Name:DENA
Middle Name:
Last Name:PINSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:DENA
Other - Middle Name:
Other - Last Name:PINSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 31331
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-0023
Mailing Address - Country:US
Mailing Address - Phone:405-620-3499
Mailing Address - Fax:
Practice Address - Street 1:5500 N WESTERN AVE STE 157
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-4018
Practice Address - Country:US
Practice Address - Phone:405-510-0850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2019-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK934103TH0100X, 103TS0200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK934OtherOKLAHOMA STATE BOARD OF EXAMINERS OF PSYCHOLOGISTS
OK12525097OtherCAQH
OK200478120 AMedicaid