| NPI | 1376587139 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELISA M WOODHEAD Credentialing Manager 918-299-8232 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical |
| 103TC1900X Psychologist, Counseling | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2019-10-07 |