Provider Demographics
NPI:1033433206
Name:GEDMIN PSYCHOLOGICAL SERVICES, PC
Entity Type:Organization
Organization Name:GEDMIN PSYCHOLOGICAL SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANA
Authorized Official - Middle Name:WILLIAMS
Authorized Official - Last Name:GEDMIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:405-801-2837
Mailing Address - Street 1:1006 24TH AVE NW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6344
Mailing Address - Country:US
Mailing Address - Phone:405-801-2837
Mailing Address - Fax:
Practice Address - Street 1:1006 24TH AVE NW
Practice Address - Street 2:SUITE 100
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6344
Practice Address - Country:US
Practice Address - Phone:405-801-2837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1045103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty