Provider Demographics
NPI:1952506370
Name:DICKISON, LANCE F (LPC NCC)
Entity Type:Individual
Prefix:MR
First Name:LANCE
Middle Name:F
Last Name:DICKISON
Suffix:
Gender:M
Credentials:LPC NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463 SW 579 LOOP
Mailing Address - Street 2:BLDG. 'B'
Mailing Address - City:CHOUTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74337
Mailing Address - Country:US
Mailing Address - Phone:918-476-0501
Mailing Address - Fax:918-207-3064
Practice Address - Street 1:463 SW 579 LOOP
Practice Address - Street 2:BLDG. 'B'
Practice Address - City:CHOUTEAU
Practice Address - State:OK
Practice Address - Zip Code:74337
Practice Address - Country:US
Practice Address - Phone:918-476-0501
Practice Address - Fax:918-207-3064
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-16
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3005101YP2500X
OK#3005101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional