MEDICARE: DRAGONFLY PSYCHOTHERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1245855857
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRAGONFLY PSYCHOTHERAPY LLC

Provider Business Mailing Address
First Line	:	2942 NE ORLIE DR
Second Line	:
City	:	FOREST PARK
State	:	OK
Zip	:	73121-2436
Country	:	US
Telephone Number	:	405-219-2529
Fax Number	:

Provider Business Practice Location Address
First Line	:	916 NW 139TH STREET PKWY
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73013-9525
Country	:	US
Telephone Number	:	405-219-2529
Fax Number	:	855-704-1609

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	JOSEPH CODY COX
Credential	:	LCSW
Telephone Number	:	405-219-2529

Provider Enumeration Date	:	06/09/2020
Last Update Date	:	11/17/2020

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