Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 4169 | AZ |
Y | 103G00000X | Clinical Psychologist | 4169 | AZ |
Y | 103TC0700X | Clinical Psychologist | 4169 | AZ |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 4169 | AZ |
NPI | 1255638904 |
---|---|
Provider Name | Dr. Denise M Dart |
First Address | Broken Arrow, OK 74012-4569 |
Second Address | Tulsa, OK 74104-1831 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2011 |
Last Update Date | 28/07/2017 |