Provider Demographics
NPI:1447972864
Name:TOTAL ECLIPSE DMH PLLC
Entity type:Organization
Organization Name:TOTAL ECLIPSE DMH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:OLEATH
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:469-427-9708
Mailing Address - Street 1:817 S ELM PL STE C
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-5369
Mailing Address - Country:US
Mailing Address - Phone:918-940-4734
Mailing Address - Fax:918-940-4737
Practice Address - Street 1:817 S ELM PL STE C
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-5369
Practice Address - Country:US
Practice Address - Phone:918-940-4734
Practice Address - Fax:918-940-4737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Single Specialty