Provider Demographics
NPI:1316186000
Name:PHILIP R BUDD, PSYD PLLC
Entity Type:Organization
Organization Name:PHILIP R BUDD, PSYD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:R
Authorized Official - Last Name:BUDD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:405-990-8204
Mailing Address - Street 1:16301 SONOMA PARK DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-2091
Mailing Address - Country:US
Mailing Address - Phone:405-246-5433
Mailing Address - Fax:405-562-1451
Practice Address - Street 1:16301 SONOMA PARK DR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-2091
Practice Address - Country:US
Practice Address - Phone:405-246-5433
Practice Address - Fax:405-562-1451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK741251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health