Provider Demographics
NPI:1194155374
Name:DISHONG, ERIN (MS, LPC)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:DISHONG
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 MAYBERRY DR
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-4603
Mailing Address - Country:US
Mailing Address - Phone:918-453-1108
Mailing Address - Fax:918-453-2019
Practice Address - Street 1:1140 MAYBERRY DR
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-4603
Practice Address - Country:US
Practice Address - Phone:918-453-1108
Practice Address - Fax:918-453-2019
Is Sole Proprietor?:No
Enumeration Date:2013-11-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7086101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100746170Medicaid