Provider Demographics
NPI:1598966749
Name:DOTSON, LARRY GENE (MS UNDER LPC SUPERVI)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:GENE
Last Name:DOTSON
Suffix:
Gender:M
Credentials:MS UNDER LPC SUPERVI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3112 N IRONWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-1769
Mailing Address - Country:US
Mailing Address - Phone:918-698-7684
Mailing Address - Fax:
Practice Address - Street 1:616 S BOSTON AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74119-1208
Practice Address - Country:US
Practice Address - Phone:918-382-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKUNDER SUPERVISION101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health