Provider Demographics
NPI:1508989153
Name:BEHAVIORAL MEDICINE ASSOCIATES, INC.
Entity Type:Organization
Organization Name:BEHAVIORAL MEDICINE ASSOCIATES, INC.
Other - Org Name:CHILDRENS INSTITUTE OF BEHAVIORAL MEDICINE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:405-878-3432
Mailing Address - Street 1:3200 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-1744
Mailing Address - Country:US
Mailing Address - Phone:405-878-3432
Mailing Address - Fax:405-395-5699
Practice Address - Street 1:3200 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-1744
Practice Address - Country:US
Practice Address - Phone:405-878-3432
Practice Address - Fax:405-395-5699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK286103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID