Provider Demographics
NPI:1669089553
Name:CHISSOE, DAVID HOWARD (EDD, LPC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:HOWARD
Last Name:CHISSOE
Suffix:
Gender:M
Credentials:EDD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-8801
Mailing Address - Country:US
Mailing Address - Phone:405-325-2911
Mailing Address - Fax:405-325-1478
Practice Address - Street 1:620 ELM AVE
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-8801
Practice Address - Country:US
Practice Address - Phone:405-325-2911
Practice Address - Fax:405-325-1478
Is Sole Proprietor?:No
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1818101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health