Provider Demographics
NPI:1457471765
Name:POYNER PSYCHOLOGICAL SERVICES, INC.
Entity Type:Organization
Organization Name:POYNER PSYCHOLOGICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:POYNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:405-741-2844
Mailing Address - Street 1:14453 SE 29TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020-6541
Mailing Address - Country:US
Mailing Address - Phone:405-741-2844
Mailing Address - Fax:405-733-1334
Practice Address - Street 1:14453 SE 29TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:CHOCTAW
Practice Address - State:OK
Practice Address - Zip Code:73020-6541
Practice Address - Country:US
Practice Address - Phone:405-741-2844
Practice Address - Fax:405-733-1334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK950103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200086310 AMedicaid
OK249503803Medicare PIN
OK900522229Medicare ID - Type UnspecifiedPROVIDER NUMBER