| NPI | 1023699956 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL L PENA Credentialing Specialist 405-272-7452 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry |
| Additional Taxonomies | 261QM1300X Clinic/Center Multi-Specialty |
| Enumeration Date | 2021-04-21 |
| Last Update Date | 2021-04-21 |