Healthcare Provider Details

I. General information

NPI: 1043384290
Provider Name (Legal Business Name): KELLI JEAN DODSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

932 N. FLOOD AVE.
NORMAN OK
73069
US

IV. Provider business mailing address

1513 ORIOLE DR
NORMAN OK
73071-6126
US

V. Phone/Fax

Practice location:
  • Phone: 405-321-3719
  • Fax: 405-364-3209
Mailing address:
  • Phone: 405-573-9749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2720
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: