Individual
MR. JOHNNY DALE DORITY I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BHRS
Contact information
Practice address
907 S WALNUT ST, SALLISAW, OK 74955-6841
(918) 708-6169
Mailing address
907 S WALNUT ST, SALLISAW, OK 74955-6841
(918) 708-6169
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
09/14/2012
Last updated
09/14/2012
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