Healthcare Provider Details

I. General information

NPI: 1205893674
Provider Name (Legal Business Name): PSYCHIATRIC ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 07/15/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6406 N SANTA FE AVE STE A
OKLAHOMA CITY OK
73116-9117
US

IV. Provider business mailing address

6406 N SANTA FE AVE STE A
OKLAHOMA CITY OK
73116-9117
US

V. Phone/Fax

Practice location:
  • Phone: 405-840-3793
  • Fax: 405-840-3794
Mailing address:
  • Phone: 405-840-3793
  • Fax: 405-840-3794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: FAY MITCHELL
Title or Position: OFFICE MANAGER
Credential:
Phone: 405-840-3793