Provider Demographics
NPI:1528644630
Name:KLUSMAN, DORIE MAE (LPC)
Entity type:Individual
Prefix:MRS
First Name:DORIE
Middle Name:MAE
Last Name:KLUSMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18641 E 80TH ST N
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-8227
Mailing Address - Country:US
Mailing Address - Phone:918-230-8256
Mailing Address - Fax:
Practice Address - Street 1:9455 N OWASSO EXPY STE K
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-5442
Practice Address - Country:US
Practice Address - Phone:918-636-5597
Practice Address - Fax:918-609-5162
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5294101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional