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General NPI Number Information
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NPI Number | 1598061780
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Entity Type | Individual
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Provider Name | DIANE CONSTANCE KIRK PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 02/04/2011
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Last Update Date | 10/28/2016
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Provider Practice Location Address
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Address Line | 3010 S HARVARD AVENUE SUITE 110
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City | TULSA
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State | OK
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Zip | 74114-6124
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Country | US
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Telephone | 302-948-6030
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Fax | 918-749-1841
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Provider Business Mailing Address
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Address Line | 1616 E 32ND PL
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City | TULSA
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State | OK
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Zip | 74105-2117
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Country | US
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Telephone | 918-992-7006
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Fax | 918-749-1841
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | B1-0000315
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1234
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License Number State | OK
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