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General NPI Number Information
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NPI Number | 1588901912
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Entity Type | Individual
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Provider Name | DENA P FANNING LPC
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Gender | Female
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Dates
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Enumeration Date | 01/04/2013
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Last Update Date | 01/04/2013
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Provider Practice Location Address
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Address Line | 10321 N 2274 RD
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City | CLINTON
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State | OK
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Zip | 73601-7521
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Country | US
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Telephone | 580-331-3300
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Fax | 580-323-2579
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Provider Business Mailing Address
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Address Line | 312 N 17TH ST
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City | CLINTON
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State | OK
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Zip | 73601-2614
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Country | US
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Telephone | 405-219-0294
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 3568
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License Number State | OK
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