Provider Demographics
NPI:1124340732
Name:DOTY, TIMOTHY DALE (PSYD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:DALE
Last Name:DOTY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6846 S CANTON AVE
Mailing Address - Street 2:#501
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3412
Mailing Address - Country:US
Mailing Address - Phone:918-745-0095
Mailing Address - Fax:918-745-0190
Practice Address - Street 1:6846 S CANTON AVE
Practice Address - Street 2:#501
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3412
Practice Address - Country:US
Practice Address - Phone:918-745-0095
Practice Address - Fax:918-745-0190
Is Sole Proprietor?:No
Enumeration Date:2010-02-23
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1118103TC0700X, 103TC1900X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling