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General NPI Number Information
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NPI Number | 1720522584
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Entity Type | Organization
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Legal Business Name | DEARDORF FAMILY SERVICES, INC.
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Dates
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Enumeration Date | 12/13/2016
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Last Update Date | 12/13/2016
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Provider Practice Location Address
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Address Line | 123 E TONHAWA ST SUITE 100
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City | NORMAN
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State | OK
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Zip | 73069-7209
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Country | US
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Telephone | 405-701-6012
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Fax |
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Provider Business Mailing Address
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Address Line | 1020 SHADOWLAKE RD
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City | NORMAN
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State | OK
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Zip | 73071-6877
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Country | US
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Telephone | 316-655-8577
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | EMILY DEARDORF
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Credential | MA, LPC
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Telephone | 316-655-8577
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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 | 4786
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License Number State | OK
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