Provider Demographics
NPI:1316246754
Name:OSU PSYCHOLOGICAL SERVICE CENTER
Entity type:Organization
Organization Name:OSU PSYCHOLOGICAL SERVICE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:R
Authorized Official - Middle Name:MATT
Authorized Official - Last Name:ALDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:405-744-5975
Mailing Address - Street 1:118 N MURRAY HALL
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74078-3060
Mailing Address - Country:US
Mailing Address - Phone:405-744-5975
Mailing Address - Fax:405-744-2826
Practice Address - Street 1:118 N MURRAY HALL
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74078-3060
Practice Address - Country:US
Practice Address - Phone:405-744-5975
Practice Address - Fax:405-744-2826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty