Provider Demographics
NPI:1043393234
Name:GRUNDY, CURTIS TODD (PHD)
Entity Type:Individual
Prefix:DR
First Name:CURTIS
Middle Name:TODD
Last Name:GRUNDY
Suffix:
Gender:M
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:PO BOX 426
Mailing Address - Street 2:
Mailing Address - City:VINITA
Mailing Address - State:OK
Mailing Address - Zip Code:74301-0426
Mailing Address - Country:US
Mailing Address - Phone:918-629-8664
Mailing Address - Fax:918-782-4301
Practice Address - Street 1:1520 NORTH INDUSTRIAL RD
Practice Address - Street 2:
Practice Address - City:VINITA
Practice Address - State:OK
Practice Address - Zip Code:74301
Practice Address - Country:US
Practice Address - Phone:918-629-8664
Practice Address - Fax:918-782-4301
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK751103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service