Healthcare Provider Details

I. General information

NPI: 1144678137
Provider Name (Legal Business Name): PHILIP DAVIS PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2016
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3037 NW 63RD ST
OKLAHOMA CITY OK
73116-3637
US

IV. Provider business mailing address

9905 S PENNSYLVANIA AVE STE A
OKLAHOMA CITY OK
73159-6920
US

V. Phone/Fax

Practice location:
  • Phone: 405-358-3706
  • Fax:
Mailing address:
  • Phone: 405-358-3706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1496
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: