Healthcare Provider Details

I. General information

NPI: 1902050842
Provider Name (Legal Business Name): DCC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2008
Last Update Date: 12/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5272 S LEWIS AVE 250
TULSA OK
74105-6544
US

IV. Provider business mailing address

5272 S LEWIS AVE 250
TULSA OK
74105-6544
US

V. Phone/Fax

Practice location:
  • Phone: 918-524-3300
  • Fax: 918-524-3302
Mailing address:
  • Phone: 918-524-3300
  • Fax: 918-524-3302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DENNIS CAVENAH
Title or Position: OWNER
Credential:
Phone: 918-524-3300