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General NPI Number Information
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NPI Number | 1629569264
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Entity Type | Organization
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Legal Business Name | TULSA PROFESSIONAL PSYCHOLOGY, PLLC
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Dates
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Enumeration Date | 05/18/2018
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Last Update Date | 05/18/2018
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Provider Practice Location Address
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Address Line | 3144 S WINSTON AVE STE A
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City | TULSA
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State | OK
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Zip | 74135-2012
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Country | US
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Telephone | 918-878-8072
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Fax | 918-878-8072
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Provider Business Mailing Address
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Address Line | 1745 S CANTON AVE
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City | TULSA
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State | OK
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Zip | 74112-6937
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Country | US
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Telephone | 918-878-8072
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Fax |
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Authorized Official
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Title or Position | CO-PRESIDENT
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Name | DR. TIMOTHY DOTY
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Credential | PSY.D.
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Telephone | 918-878-8072
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number | 1225
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1225
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1118
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License Number State | OK
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Taxonomy #4
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Taxonomy Code | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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License Number | 1118
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License Number State | OK
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Taxonomy #5
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number | 1118
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License Number State | OK
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