Provider Demographics
NPI:1730404252
Name:SIMPSON, TERRY LYNN
Entity type:Individual
Prefix:MR
First Name:TERRY
Middle Name:LYNN
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:TERRY
Other - Middle Name:LYNN
Other - Last Name:SIMPSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CADC
Mailing Address - Street 1:PO BOX 5937
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-5937
Mailing Address - Country:US
Mailing Address - Phone:405-713-5982
Mailing Address - Fax:405-685-1942
Practice Address - Street 1:2129 SW 59TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73119-7024
Practice Address - Country:US
Practice Address - Phone:405-713-5982
Practice Address - Fax:405-685-1942
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-29
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1280101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)