Healthcare Provider Details

I. General information

NPI: 1215984505
Provider Name (Legal Business Name): ALLAN LOUIS DUPUIS LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 MCGEE DR, SUITE 104
NORMAN OK
73072-6705
US

IV. Provider business mailing address

2500 MCGEE DR, SUITE 104
NORMAN OK
73072-6705
US

V. Phone/Fax

Practice location:
  • Phone: 405-573-9728
  • Fax: 405-573-9727
Mailing address:
  • Phone: 405-573-9728
  • Fax: 405-573-9727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number3360
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3360
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: