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General NPI Number Information
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NPI Number | 1598966749
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Entity Type | Individual
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Provider Name | LARRY GENE DOTSON MS UNDER LPC SUPERVI
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Gender | Male
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Dates
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Enumeration Date | 05/29/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 616 S BOSTON AVE
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City | TULSA
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State | OK
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Zip | 74119-1208
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Country | US
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Telephone | 918-382-7300
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Fax |
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Provider Business Mailing Address
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Address Line | 3112 N IRONWOOD AVE
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City | BROKEN ARROW
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State | OK
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Zip | 74012-1769
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Country | US
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Telephone | 918-698-7684
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | UNDER SUPERVISION
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License Number State | OK
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