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General NPI Number Information
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NPI Number | 1457827016
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Entity Type | Organization
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Legal Business Name | GRUNDY PSYCHOLOGICAL SERVICES, P.C.
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Dates
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Enumeration Date | 10/22/2018
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Last Update Date | 10/22/2018
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Provider Practice Location Address
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Address Line | 205 KETCHUM AVENUE
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City | KETCHUM
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State | OK
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Zip | 74349
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Country | US
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Telephone | 918-629-8664
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Fax | 918-782-4301
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Provider Business Mailing Address
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Address Line | PO BOX 6
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City | KETCHUM
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State | OK
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Zip | 74349-0006
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Country | US
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Telephone | 918-629-8664
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Fax | 918-782-4301
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. ELIZABETH MOLLETTE GRUNDY
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Credential | PH.D.
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Telephone | 918-855-8315
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number |
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License Number State |
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