Healthcare Provider Details

I. General information

NPI: 1407946999
Provider Name (Legal Business Name): JOSEPH ALLEN BANKEN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 NW 56TH ST
OKLAHOMA CITY OK
73112-4538
US

IV. Provider business mailing address

PO BOX 31434
EDMOND OK
73003-0024
US

V. Phone/Fax

Practice location:
  • Phone: 405-724-8921
  • Fax:
Mailing address:
  • Phone: 501-352-5544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1336
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number99-5P
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number99-5P
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: