Doctor Name: | MR. NELSON EDDIE DICKENSON |
NPI Number: | 1871612119 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | B.A. , C.M. , R.S.S. |
License Number: | |
Business Practice Address: | Hc 74 Box 32-5 Hartshorne, OK - 745479700 |
Business Phone Number: | 9182972495 |
Business Fax Number: | |
Mailing Address: | Hc 74 Box 32-5, HARTSHORNE |
State: | OK |
Postal Code: | 745479700 |
Phone Number: | 9182972495 |
Fax Number: | |
NPI Enumeration Date: | 03/28/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TR0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Rehabilitation |
Taxonomy Definition: |