Provider Demographics
NPI:1760665392
Name:FISHKIN, STEVEN M (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:M
Last Name:FISHKIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2228 NW 119TH TER
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-7817
Mailing Address - Country:US
Mailing Address - Phone:405-751-6474
Mailing Address - Fax:
Practice Address - Street 1:2228 NW 119TH TER
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-7817
Practice Address - Country:US
Practice Address - Phone:405-751-6474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK405103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical