MEDICARE: ELIZABETH CLAIRE RISCH PH.D.

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	1110	OK

General Provider Information

NPI Number	:	1912211004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH CLAIRE RISCH PH.D.

Provider Business Mailing Address
First Line	:	940 NE 13TH ST
Second Line	:	3B-3406
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-5008
Country	:	US
Telephone Number	:	405-271-8858
Fax Number	:	405-271-2931

Provider Business Practice Location Address
First Line	:	940 NE 13TH ST
Second Line	:	3B-3406
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-5008
Country	:	US
Telephone Number	:	405-271-8858
Fax Number	:	405-271-2931

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2010
Last Update Date	:	07/30/2010

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