Healthcare Provider Details

I. General information

NPI: 1417692815
Provider Name (Legal Business Name): ASHCO PSYCH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2022
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 S ELM PL
BROKEN ARROW OK
74012-5369
US

IV. Provider business mailing address

406 VALLEY VIEW RD
CLEVELAND OK
74020-9707
US

V. Phone/Fax

Practice location:
  • Phone: 918-497-8138
  • Fax:
Mailing address:
  • Phone: 918-497-8138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY ANN TOTTEN-GILBERT
Title or Position: OWNER
Credential:
Phone: 918-497-8138