Provider Demographics
NPI:1528768033
Name:FENTON, TIMOTHY (LADC/MH)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:FENTON
Suffix:
Gender:M
Credentials:LADC/MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 N LEE AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-2620
Mailing Address - Country:US
Mailing Address - Phone:405-516-0343
Mailing Address - Fax:
Practice Address - Street 1:1111 N LEE AVE STE 207
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-2620
Practice Address - Country:US
Practice Address - Phone:405-516-0343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)