Provider Demographics
NPI:1053650903
Name:PSYCHOLOGICAL SERVICES, PC
Entity Type:Organization
Organization Name:PSYCHOLOGICAL SERVICES, PC
Other - Org Name:MICHAEL LOCK, PH.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOCK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:918-804-7561
Mailing Address - Street 1:4815 S HARVARD AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-3060
Mailing Address - Country:US
Mailing Address - Phone:918-804-7561
Mailing Address - Fax:918-392-4845
Practice Address - Street 1:4815 S HARVARD AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-3060
Practice Address - Country:US
Practice Address - Phone:918-804-7561
Practice Address - Fax:918-392-4845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-12
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK611103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty