Provider Demographics
NPI:1629170550
Name:DORHOLT TANDY, LORIE (MS, LPC, LLC)
Entity Type:Individual
Prefix:MRS
First Name:LORIE
Middle Name:
Last Name:DORHOLT TANDY
Suffix:
Gender:F
Credentials:MS, LPC, LLC
Other - Prefix:MRS
Other - First Name:AMY
Other - Middle Name:LORIE
Other - Last Name:DORHOLT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:4870 S LEWIS AVE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-5151
Mailing Address - Country:US
Mailing Address - Phone:918-494-5659
Mailing Address - Fax:918-551-6619
Practice Address - Street 1:4870 S LEWIS AVE
Practice Address - Street 2:SUITE 115
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-5177
Practice Address - Country:US
Practice Address - Phone:918-494-5659
Practice Address - Fax:918-551-6619
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2039101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health