Provider Demographics
NPI:1942211958
Name:B. TODD GRAYBILL, PH.D., P.L.L.C.
Entity Type:Organization
Organization Name:B. TODD GRAYBILL, PH.D., P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:B.
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:GRAYBILL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:918-683-8827
Mailing Address - Street 1:333 S 38TH ST
Mailing Address - Street 2:SUITE K
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-4937
Mailing Address - Country:US
Mailing Address - Phone:918-683-8827
Mailing Address - Fax:918-686-0902
Practice Address - Street 1:333 S 38TH ST
Practice Address - Street 2:SUITE K
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-4937
Practice Address - Country:US
Practice Address - Phone:918-683-8827
Practice Address - Fax:918-686-0902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK353103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK443-48-2619-002OtherBLUE CROSS BLUE SHIELD
OKR11307Medicare UPIN