Provider Demographics
NPI:1093118408
Name:PSYCHOLOGICAL SERVICES OF TULSA, LLC
Entity Type:Organization
Organization Name:PSYCHOLOGICAL SERVICES OF TULSA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SNIDER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:918-492-2480
Mailing Address - Street 1:7020 S YALE AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-5715
Mailing Address - Country:US
Mailing Address - Phone:918-492-2480
Mailing Address - Fax:918-477-9446
Practice Address - Street 1:7020 S YALE AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-5715
Practice Address - Country:US
Practice Address - Phone:918-492-2480
Practice Address - Fax:918-477-9446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK913103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100851550AMedicaid