Healthcare Provider Details

I. General information

NPI: 1548448608
Provider Name (Legal Business Name): PAMELA ANN VROOMAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2008
Last Update Date: 01/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 S ELWOOD AVE
TULSA OK
74119-4208
US

IV. Provider business mailing address

2524 E 20TH ST
TULSA OK
74104-5810
US

V. Phone/Fax

Practice location:
  • Phone: 918-587-3888
  • Fax: 918-587-3891
Mailing address:
  • Phone: 918-743-6255
  • Fax: 918-743-0649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1056
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: