MEDICARE: HEATHER DORMAN LADC/MH

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	1279	OK
2	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1598158321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER DORMAN LADC/MH

Provider Business Mailing Address
First Line	:	1625 GREENBRIAR PL STE 200
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-7645
Country	:	US
Telephone Number	:	405-365-9556
Fax Number	:	405-703-9354

Provider Business Practice Location Address
First Line	:	1625 GREENBRIAR PL STE 200
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-7645
Country	:	US
Telephone Number	:	405-365-9556
Fax Number	:	405-703-9354

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2015
Last Update Date	:	03/25/2022

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Directions to “ HEATHER DORMAN LADC/MH” Practice Location

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