Provider Demographics
NPI:1285416792
Name:SLAUGHTER, AUTUMN (PHD)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:
Last Name:SLAUGHTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14502 E 110TH ST N
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-5998
Mailing Address - Country:US
Mailing Address - Phone:903-243-8645
Mailing Address - Fax:
Practice Address - Street 1:24800 S 4420 RD
Practice Address - Street 2:
Practice Address - City:VINITA
Practice Address - State:OK
Practice Address - Zip Code:74301-5544
Practice Address - Country:US
Practice Address - Phone:918-256-7841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1439103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist