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General NPI Number Information
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NPI Number | 1689877292
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Entity Type | Individual
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Provider Name | ALICIA ANN IRVIN PH.D.
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Gender | Female
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Dates
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Enumeration Date | 06/09/2007
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Last Update Date | 09/10/2008
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Provider Practice Location Address
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Address Line | 442104 E. 250 RD
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City | VINITA
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State | OK
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Zip | 74301
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Country | US
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Telephone | 918-256-7841
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Fax |
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Provider Business Mailing Address
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Address Line | 8243 S COLLEGE AVE
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City | TULSA
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State | OK
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Zip | 74137-1321
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Country | US
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Telephone | 918-816-7597
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Fax |
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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