Provider Demographics
NPI:1568720951
Name:PSYCHIATRY AND PSYCHOTHERAPY OF CENTRAL OKLAHOMA, PLLC
Entity Type:Organization
Organization Name:PSYCHIATRY AND PSYCHOTHERAPY OF CENTRAL OKLAHOMA, PLLC
Other - Org Name:OKLAHOMA BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:PEYTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-607-2233
Mailing Address - Street 1:2301 W I 44 SERVICE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-8729
Mailing Address - Country:US
Mailing Address - Phone:405-607-2233
Mailing Address - Fax:405-286-1303
Practice Address - Street 1:2301 W I 44 SERVICE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-8729
Practice Address - Country:US
Practice Address - Phone:405-607-2233
Practice Address - Fax:405-286-1303
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PSYCHIATRY AND PSYCHOTHERAPY OF CENTRAL OKLAHOMA, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-24
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK240052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty