Provider Demographics
NPI:1295257020
Name:DANDRIDGE, MONICA LEE (M ED, LPC)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:LEE
Last Name:DANDRIDGE
Suffix:
Gender:F
Credentials:M ED, LPC
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:LEE
Other - Last Name:DAWSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, LPC
Mailing Address - Street 1:90448 S 4687 RD
Mailing Address - Street 2:
Mailing Address - City:BUNCH
Mailing Address - State:OK
Mailing Address - Zip Code:74931-5160
Mailing Address - Country:US
Mailing Address - Phone:918-905-1511
Mailing Address - Fax:
Practice Address - Street 1:90448 S 4687 RD
Practice Address - Street 2:
Practice Address - City:BUNCH
Practice Address - State:OK
Practice Address - Zip Code:74931-5160
Practice Address - Country:US
Practice Address - Phone:918-905-1511
Practice Address - Fax:918-905-1511
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-13
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7477101YP2500X
103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional