Provider Demographics
NPI:1558939736
Name:DARK, ESTHER VICTORIA
Entity Type:Individual
Prefix:
First Name:ESTHER
Middle Name:VICTORIA
Last Name:DARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ESTHER
Other - Middle Name:VICTORIA
Other - Last Name:FRYC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10621 E 113TH ST N
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-4256
Mailing Address - Country:US
Mailing Address - Phone:580-291-9847
Mailing Address - Fax:
Practice Address - Street 1:650 S PEORIA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-4429
Practice Address - Country:US
Practice Address - Phone:918-587-9471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor