MEDICARE: INSIGHT PSYCHOLOGICAL SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	1247	OK

General Provider Information

NPI Number	:	1881049674
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSIGHT PSYCHOLOGICAL SERVICES

Provider Business Mailing Address
First Line	:	5230 E 69TH PL
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-3407
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5230 E 69TH PL
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-3407
Country	:	US
Telephone Number	:	304-710-1678
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOLOGIST/OWNER
Name	:	NATHAN BRUSICH
Credential	:	PSY.D.
Telephone Number	:	304-710-1678

Provider Enumeration Date	:	04/28/2016
Last Update Date	:	04/28/2016

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