Provider Demographics
NPI:1568632776
Name:TULSA CENTER FOR CHILD PSYCHOLOGY PLLC
Entity Type:Organization
Organization Name:TULSA CENTER FOR CHILD PSYCHOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:918-779-7637
Mailing Address - Street 1:6966 S UTICA AVE
Mailing Address - Street 2:STE 225
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3903
Mailing Address - Country:US
Mailing Address - Phone:918-492-6333
Mailing Address - Fax:
Practice Address - Street 1:5110 S YALE AVE
Practice Address - Street 2:STE 103
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-7401
Practice Address - Country:US
Practice Address - Phone:918-779-7637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK508103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty