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General NPI Number Information
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NPI Number | 1316246754
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Entity Type | Organization
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Legal Business Name | OSU PSYCHOLOGICAL SERVICE CENTER
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Dates
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Enumeration Date | 03/24/2011
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Last Update Date | 03/24/2011
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Provider Practice Location Address
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Address Line | 118 N MURRAY HALL
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City | STILLWATER
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State | OK
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Zip | 74078-3060
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Country | US
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Telephone | 405-744-5975
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Fax | 405-744-2826
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Provider Business Mailing Address
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Address Line | 118 N MURRAY HALL
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City | STILLWATER
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State | OK
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Zip | 74078-3060
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Country | US
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Telephone | 405-744-5975
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Fax | 405-744-2826
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | DR. R MATT ALDERSON
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Credential | PHD
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Telephone | 405-744-5975
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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 |
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License Number State |
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