Provider Demographics
NPI:1427000843
Name:PSYCHOTHERAPY & DIAGNOSTIC SERVICES, INC.
Entity type:Organization
Organization Name:PSYCHOTHERAPY & DIAGNOSTIC SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:DAVES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:405-366-8828
Mailing Address - Street 1:1818 W. LINDSEY ST
Mailing Address - Street 2:SUITE C-120
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-4169
Mailing Address - Country:US
Mailing Address - Phone:405-366-8828
Mailing Address - Fax:405-325-1478
Practice Address - Street 1:1818 W LINDSEY ST
Practice Address - Street 2:SUITE C-120
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-4159
Practice Address - Country:US
Practice Address - Phone:405-366-8828
Practice Address - Fax:405-325-1478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK115101YM0800X
OK493103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK========= 02Medicare UPIN
OK00051125351Medicare UPIN
OK443482662-003Medicare UPIN