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General NPI Number Information
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NPI Number | 1689213936
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Entity Type | Organization
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Legal Business Name | FORDUCEY PROFESSIONAL CONSULTING
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Dates
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Enumeration Date | 01/04/2020
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Last Update Date | 01/04/2020
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Provider Practice Location Address
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Address Line | 16301 SONOMA PARK DR
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City | EDMOND
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State | OK
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Zip | 73013-2091
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Country | US
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Telephone | 405-550-3482
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Fax |
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Provider Business Mailing Address
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Address Line | 2717 NW 55TH PL
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-7010
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | PAM FORDUCEY
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Credential | PHD
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Telephone | 405-550-3482
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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