MEDICARE: ERIN GROVES MA, MS, PSYD

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	NA	IN

General Provider Information

NPI Number	:	1922835750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN GROVES MA, MS, PSYD

Provider Business Mailing Address
First Line	:	204 SW 144TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-7262
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	204 SW 144TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-7262
Country	:	US
Telephone Number	:	405-926-7162
Fax Number	:

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

Provider Enumeration Date	:	09/16/2024
Last Update Date	:	09/16/2024

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