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General NPI Number Information
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NPI Number | 1871761106
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Entity Type | Organization
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Legal Business Name | LEAH DICK & ASSOCIATES PC
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Dates
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Enumeration Date | 02/20/2008
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Last Update Date | 02/20/2008
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Provider Practice Location Address
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Address Line | 1001 SW B AVE SUITE 120
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City | LAWTON
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State | OK
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Zip | 73501-3965
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Country | US
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Telephone | 580-248-8644
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Fax | 580-248-8666
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Provider Business Mailing Address
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Address Line | 1001 SW B AVE SUITE 120
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City | LAWTON
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State | OK
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Zip | 73501-3965
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Country | US
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Telephone | 580-248-8644
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Fax | 580-248-8666
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Authorized Official
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Title or Position | PSYCHOLOGIST/OWNER
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Name | LEAH D DICK
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Credential | PHD
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Telephone | 580-248-8644
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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 | 196
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License Number State | OK
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