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General NPI Number Information
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NPI Number | 1780957779
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Entity Type | Individual
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Provider Name | BRIAN JOHN BIGELOW PH.D., ABPP
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Gender | Male
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Dates
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Enumeration Date | 02/22/2012
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Last Update Date | 02/22/2012
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Provider Practice Location Address
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Address Line | 813 SW B AVE
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City | LAWTON
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State | OK
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Zip | 73501-3954
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Country | US
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Telephone | 580-482-3900
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Fax | 580-248-1987
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Provider Business Mailing Address
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Address Line | BOX 458 20 RIDEAU AVE.
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City | CONISTON
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State | ONTARIO
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Zip | P0M1M0
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Country | CA
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Telephone | 705-694-5719
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 995
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 995
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License Number State | ZZ
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