Healthcare Provider Details

I. General information

NPI: 1699704270
Provider Name (Legal Business Name): PROFESSIONAL CORPORATION OF PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 N BROOKLINE AVE 900
OKLAHOMA CITY OK
73112-3623
US

IV. Provider business mailing address

5100 N BROOKLINE AVE 900
OKLAHOMA CITY OK
73112-3623
US

V. Phone/Fax

Practice location:
  • Phone: 405-604-3170
  • Fax: 405-604-3163
Mailing address:
  • Phone: 405-604-3170
  • Fax: 405-604-3163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN C. ANDRUS
Title or Position: PRESIDENT
Credential: MD
Phone: 405-604-3170