Healthcare Provider Details

I. General information

NPI: 1164791745
Provider Name (Legal Business Name): TERESA LYNN PIKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2011
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 N GRAND ST
ENID OK
73701-3221
US

IV. Provider business mailing address

208 N.E. 8TH ST
STIGLER OK
74462
US

V. Phone/Fax

Practice location:
  • Phone: 918-315-5491
  • Fax:
Mailing address:
  • Phone: 918-315-5491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: