Provider Demographics
NPI:1851672604
Name:JOHNSON, DORRI DONYELLE
Entity Type:Individual
Prefix:MISS
First Name:DORRI
Middle Name:DONYELLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4845 S SHERIDAN RD STE 504
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-5719
Mailing Address - Country:US
Mailing Address - Phone:918-407-1686
Mailing Address - Fax:877-245-1779
Practice Address - Street 1:2048 N. ROSEDALE AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127
Practice Address - Country:US
Practice Address - Phone:918-407-1686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health