Provider Demographics
NPI:1598859274
Name:DODD, DAVID SCOTT (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SCOTT
Last Name:DODD
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 1:4221 S. E. AVONDALE LANE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501
Mailing Address - Country:US
Mailing Address - Phone:580-355-0487
Mailing Address - Fax:580-442-7604
Practice Address - Street 1:DEPARTMENT OF ARMY, USAMEDDAC
Practice Address - Street 2:ATTN: MCUA-CMH
Practice Address - City:FT. SILL
Practice Address - State:OK
Practice Address - Zip Code:73503-6300
Practice Address - Country:US
Practice Address - Phone:580-442-4833
Practice Address - Fax:580-442-7604
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK839103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical