Provider Demographics
NPI:1255638904
Name:DART, DENISE M (PSYD)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:M
Last Name:DART
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:DENISE
Other - Middle Name:M
Other - Last Name:GLASSMOYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:1205 S UMBRELLA AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-4569
Mailing Address - Country:US
Mailing Address - Phone:602-885-5026
Mailing Address - Fax:
Practice Address - Street 1:2321 E 3RD ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-1831
Practice Address - Country:US
Practice Address - Phone:918-622-0641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4169103TA0400X, 103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent