Individual
AMY DOLEZAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
604 S WALNUT ST, STILLWATER, OK 74074-4222
(844) 458-2100
Mailing address
710 JACKSON ST, PERRY, OK 73077-3223
(405) 205-2077
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
6212
OK
101YP2500X
Professional Counselor
2492
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200551210 B
—
OK
Enumeration date
07/23/2014
Last updated
04/02/2024
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