Healthcare Provider Details

I. General information

NPI: 1477623726
Provider Name (Legal Business Name): JOHN ATWOOD CLINICAL PSYCHOLOGIST INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 06/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 DEBORAH LN
EDMOND OK
73034-3066
US

IV. Provider business mailing address

2300 DEBORAH LN
EDMOND OK
73034-3066
US

V. Phone/Fax

Practice location:
  • Phone: 405-285-1523
  • Fax: 405-285-1523
Mailing address:
  • Phone: 405-285-1523
  • Fax: 405-285-1523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. PAT A ATWOOD
Title or Position: OFFICE MANAGER
Credential:
Phone: 405-285-1523