Healthcare Provider Details

I. General information

NPI: 1306248513
Provider Name (Legal Business Name): TERRANCE DUNN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2014
Last Update Date: 09/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 N 3RD AVE
DURANT OK
74701-4700
US

IV. Provider business mailing address

107 S HIGH ST
ANTLERS OK
74523-3818
US

V. Phone/Fax

Practice location:
  • Phone: 580-745-9276
  • Fax: 580-920-9056
Mailing address:
  • Phone: 580-298-2830
  • Fax: 580-298-6723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: