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General NPI Number Information
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NPI Number | 1063855948
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Entity Type | Organization
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Legal Business Name | CCC PSYCHOLOGICAL SERVICES, INC.
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Dates
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Enumeration Date | 04/10/2013
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Last Update Date | 04/10/2013
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Provider Practice Location Address
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Address Line | 4811 GAILLARDIA PKWY SUITE 110
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City | OKLAHOMA CITY
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State | OK
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Zip | 73142-1874
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Country | US
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Telephone | 405-325-4599
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Fax | 405-607-1178
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Provider Business Mailing Address
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Address Line | 4811 GAILLARDIA PKWY SUITE 110
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City | OKLAHOMA CITY
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State | OK
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Zip | 73142-1874
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Country | US
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Telephone | 405-325-4599
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Fax | 405-607-1178
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. CYNTHIA CHIOCO
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Credential | PSY.D.
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Telephone | 405-326-4599
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 668
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License Number State | OK
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