| NPI | 1295130508 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE ROSE RILEY Owner 918-240-9380 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TH0100X Psychologist Health Service (Licence: OK 1215) |
| Enumeration Date | 2014-10-29 |
| Last Update Date | 2015-09-22 |