Healthcare Provider Details

I. General information

NPI: 1164437604
Provider Name (Legal Business Name): LESLIE J. RUNDELL PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6520 N WESTERN AVE SUITE 200
OKLAHOMA CITY OK
73116-7334
US

IV. Provider business mailing address

6520 N WESTERN AVE SUITE 200
OKLAHOMA CITY OK
73116-7334
US

V. Phone/Fax

Practice location:
  • Phone: 405-848-2511
  • Fax: 405-848-2511
Mailing address:
  • Phone: 405-848-2511
  • Fax: 405-848-2511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number974
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number974
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: