Provider Demographics
NPI:1770815243
Name:HARTSELL PSYCHOLOGICAL SERVICES, INC.
Entity Type:Organization
Organization Name:HARTSELL PSYCHOLOGICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRTSELL
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:580-920-0909
Mailing Address - Street 1:1604 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-2128
Mailing Address - Country:US
Mailing Address - Phone:589-920-0909
Mailing Address - Fax:580-931-3119
Practice Address - Street 1:1604 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-2128
Practice Address - Country:US
Practice Address - Phone:589-920-0909
Practice Address - Fax:580-931-3119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health