Provider Demographics
NPI:1699198796
Name:DYKEMAN, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:DYKEMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 E JACKSON ST APT 1
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:OK
Mailing Address - Zip Code:74743-4047
Mailing Address - Country:US
Mailing Address - Phone:405-888-0388
Mailing Address - Fax:
Practice Address - Street 1:501 E JACKSON ST APT 1
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:OK
Practice Address - Zip Code:74743-4047
Practice Address - Country:US
Practice Address - Phone:405-888-0388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst