Provider Demographics
NPI:1104850346
Name:GARABEDIAN, KRIKOR B (PHD)
Entity Type:Individual
Prefix:DR
First Name:KRIKOR
Middle Name:B
Last Name:GARABEDIAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:GREG
Other - Middle Name:B
Other - Last Name:GARABEDIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:913 S MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4635
Mailing Address - Country:US
Mailing Address - Phone:405-743-8318
Mailing Address - Fax:405-743-8318
Practice Address - Street 1:913 S MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4635
Practice Address - Country:US
Practice Address - Phone:405-743-8318
Practice Address - Fax:405-743-8318
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK714103TB0200X, 103TC0700X, 103TC2200X, 103T00000X, 103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100631500BMedicaid
OK100631500CMedicaid