Provider Demographics
NPI:1639565831
Name:WILLIAMS, PATRICIA FAYE (SCHOOL PSYCHOMESTRIS)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:FAYE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:SCHOOL PSYCHOMESTRIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-5303
Mailing Address - Country:US
Mailing Address - Phone:918-423-5204
Mailing Address - Fax:918-423-5255
Practice Address - Street 1:111 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5303
Practice Address - Country:US
Practice Address - Phone:918-423-5204
Practice Address - Fax:918-423-5255
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200305190BMedicaid