Provider Demographics
NPI:1770509747
Name:CONGER, ALAN LEE (PSY D)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:LEE
Last Name:CONGER
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5512 S LEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-7140
Mailing Address - Country:US
Mailing Address - Phone:918-747-1600
Mailing Address - Fax:918-749-2774
Practice Address - Street 1:5512 S LEWIS AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-7140
Practice Address - Country:US
Practice Address - Phone:918-747-1600
Practice Address - Fax:918-749-2774
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2010-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK395103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100840740AMedicaid
442568789Medicare ID - Type Unspecified