Provider Demographics
NPI:1255571899
Name:DENARD, DOROTHY SUSAN (M S, LPC)
Entity type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:SUSAN
Last Name:DENARD
Suffix:
Gender:F
Credentials:M S, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 W WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-4922
Mailing Address - Country:US
Mailing Address - Phone:580-467-8906
Mailing Address - Fax:
Practice Address - Street 1:926 W WILLOW AVE
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-4922
Practice Address - Country:US
Practice Address - Phone:580-467-8906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-23
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4076101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200303980AMedicaid