Healthcare Provider Details

I. General information

NPI: 1922382373
Provider Name (Legal Business Name): MARION SIGURDSON, PH.D. PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2011
Last Update Date: 10/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 E 41ST ST SUITE 107
TULSA OK
74105-3717
US

IV. Provider business mailing address

3150 E 41ST ST SUITE 107
TULSA OK
74105-3717
US

V. Phone/Fax

Practice location:
  • Phone: 918-949-3533
  • Fax:
Mailing address:
  • Phone: 918-949-3533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number305
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number305
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number305
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number305
License Number StateOK
# 5
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number305
License Number StateOK

VIII. Authorized Official

Name: MARION SIGURDSON
Title or Position: MANAGER
Credential: PH.D.
Phone: 918-949-3533