Provider Demographics
NPI:1265159701
Name:TAWKOYTY, DIONDRICK KEENAN
Entity type:Individual
Prefix:
First Name:DIONDRICK
Middle Name:KEENAN
Last Name:TAWKOYTY
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 1:2012 NW 24TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-3917
Mailing Address - Country:US
Mailing Address - Phone:580-771-6902
Mailing Address - Fax:
Practice Address - Street 1:2012 NW 24TH ST
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-3917
Practice Address - Country:US
Practice Address - Phone:580-771-6902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)