Provider Demographics
NPI:1508847682
Name:SWINK, RICHARD HARLEN (PHD)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:HARLEN
Last Name:SWINK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:RICHARD
Other - Middle Name:HARLEN
Other - Last Name:SWINK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1616 E 19TH ST
Mailing Address - Street 2:BLDG 103
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-6627
Mailing Address - Country:US
Mailing Address - Phone:405-341-3085
Mailing Address - Fax:405-341-0128
Practice Address - Street 1:1616 E 19TH ST
Practice Address - Street 2:BLDG 103
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-6627
Practice Address - Country:US
Practice Address - Phone:405-341-3085
Practice Address - Fax:405-341-0128
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK124103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100839380AMedicaid
OK100839380BMedicaid