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Individual

LATANYA DODD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1540 E 68TH PL, TULSA, OK 74136
(317) 457-3933
Mailing address
1540 E 68TH PL, TULSA, OK 74136-4119
(317) 457-3933

Taxonomy

Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
261QM0850X
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
5400-21-9970
OKLAHOMA DRIVERS LISCENSE
OK
Enumeration date
11/15/2013
Last updated
11/15/2013
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