Healthcare Provider Details

I. General information

NPI: 1255459889
Provider Name (Legal Business Name): DENISE LAGRAND, PSY.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 W CHICKASAW ST
TAHLEQUAH OK
74464-4301
US

IV. Provider business mailing address

PO BOX 1247
TAHLEQUAH OK
74465-1247
US

V. Phone/Fax

Practice location:
  • Phone: 918-931-9600
  • Fax: 918-456-8773
Mailing address:
  • Phone: 918-931-9600
  • Fax: 918-456-8773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number04-1P
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number533
License Number StateAK
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number727
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. DENISE MICHELE LAGRAND
Title or Position: SOLE PROPRIETOR
Credential: PSY.D.
Phone: 918-931-9600