Provider Demographics
NPI:1366825713
Name:ERICA MCQUIDDY PYSD
Entity Type:Organization
Organization Name:ERICA MCQUIDDY PYSD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:ERICA
Authorized Official - Last Name:MCQUIDDY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:918-631-7581
Mailing Address - Street 1:5800 E SKELLY DR STE 1111
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-6448
Mailing Address - Country:US
Mailing Address - Phone:918-631-7581
Mailing Address - Fax:918-209-5538
Practice Address - Street 1:5800 E SKELLY DR STE 1111
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-6448
Practice Address - Country:US
Practice Address - Phone:918-631-7581
Practice Address - Fax:918-209-5538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-02
Last Update Date:2019-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1196103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty