Healthcare Provider Details

I. General information

NPI: 1497837017
Provider Name (Legal Business Name): LEE A THRASH PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 02/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 W 15TH ST STE. 7
EDMOND OK
73013-3745
US

IV. Provider business mailing address

407 W 15TH ST STE. 7
EDMOND OK
73013-3745
US

V. Phone/Fax

Practice location:
  • Phone: 405-408-4849
  • Fax:
Mailing address:
  • Phone: 405-408-4849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number1092
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: