Provider Demographics
NPI:1407884778
Name:ROACH, RACHEL LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:LYNN
Last Name:ROACH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3750 W MAIN ST
Mailing Address - Street 2:STE AA
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-4645
Mailing Address - Country:US
Mailing Address - Phone:405-364-3804
Mailing Address - Fax:405-292-3640
Practice Address - Street 1:3750 W MAIN ST
Practice Address - Street 2:STE AA
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-4645
Practice Address - Country:US
Practice Address - Phone:405-364-3804
Practice Address - Fax:405-292-3640
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK736103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK238309401Medicaid