Provider Demographics
NPI:1588053193
Name:DOSS, ERIC W (MFT)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:W
Last Name:DOSS
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3108 SE 30TH CT
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73165-7379
Mailing Address - Country:US
Mailing Address - Phone:813-451-0121
Mailing Address - Fax:
Practice Address - Street 1:3108 SE 30TH CT
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73165-7379
Practice Address - Country:US
Practice Address - Phone:813-451-0121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst