Provider Demographics
NPI:1598158321
Name:DORMAN, HEATHER (LADC/MH)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:DORMAN
Suffix:
Gender:F
Credentials:LADC/MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 GREENBRIAR PL STE 200
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-7645
Mailing Address - Country:US
Mailing Address - Phone:405-365-9556
Mailing Address - Fax:405-703-9354
Practice Address - Street 1:1625 GREENBRIAR PL STE 200
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-7645
Practice Address - Country:US
Practice Address - Phone:405-365-9556
Practice Address - Fax:405-703-9354
Is Sole Proprietor?:No
Enumeration Date:2015-03-18
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1279101YA0400X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)