Healthcare Provider Details

I. General information

NPI: 1285643981
Provider Name (Legal Business Name): DIANA G WATERS PH. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANA G BROWN PH.D.

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13301 N MERIDIAN AVE STE 100
OKLAHOMA CITY OK
73120-8357
US

IV. Provider business mailing address

13301 N MERIDIAN AVE STE 100
OKLAHOMA CITY OK
73120-8357
US

V. Phone/Fax

Practice location:
  • Phone: 405-752-9500
  • Fax: 405-752-9571
Mailing address:
  • Phone: 405-752-9500
  • Fax: 405-752-9571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number312
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: