Healthcare Provider Details

I. General information

NPI: 1255638904
Provider Name (Legal Business Name): DENISE M DART PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DENISE M GLASSMOYER PSYD

II. Dates (important events)

Enumeration Date: 02/16/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2321 E 3RD ST
TULSA OK
74104-1831
US

IV. Provider business mailing address

1205 S UMBRELLA AVE
BROKEN ARROW OK
74012-4569
US

V. Phone/Fax

Practice location:
  • Phone: 918-622-0641
  • Fax:
Mailing address:
  • Phone: 602-885-5026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number4169
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number4169
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4169
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: