1245855857 NPI number — DRAGONFLY PSYCHOTHERAPY LLC

Table of content: RICHARD JAMES HALDEMAN III PA (NPI 1194794545)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245855857 NPI number — DRAGONFLY PSYCHOTHERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRAGONFLY PSYCHOTHERAPY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245855857
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2942 NE ORLIE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOREST PARK
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73121-2436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-219-2529
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
916 NW 139TH STREET PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDMOND
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73013-9525
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-219-2529
Provider Business Practice Location Address Fax Number:
855-704-1609
Provider Enumeration Date:
06/09/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
COX
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
CODY
Authorized Official Title or Position:
PSYCHOTHERAPIST
Authorized Official Telephone Number:
405-219-2529

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)