Provider Demographics
NPI:1477623726
Name:JOHN ATWOOD CLINICAL PSYCHOLOGIST INC
Entity Type:Organization
Organization Name:JOHN ATWOOD CLINICAL PSYCHOLOGIST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAT
Authorized Official - Middle Name:A
Authorized Official - Last Name:ATWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-285-1523
Mailing Address - Street 1:2300 DEBORAH LN
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-3066
Mailing Address - Country:US
Mailing Address - Phone:405-285-1523
Mailing Address - Fax:405-285-1523
Practice Address - Street 1:2300 DEBORAH LN
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-3066
Practice Address - Country:US
Practice Address - Phone:405-285-1523
Practice Address - Fax:405-285-1523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty