Provider Demographics
NPI:1952506727
Name:BEDWELL, HORACE WADE (PHD)
Entity Type:Individual
Prefix:DR
First Name:HORACE
Middle Name:WADE
Last Name:BEDWELL
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 1:7945 S LAKEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-9106
Mailing Address - Country:US
Mailing Address - Phone:918-494-4945
Mailing Address - Fax:
Practice Address - Street 1:7945 S LAKEWOOD AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-9106
Practice Address - Country:US
Practice Address - Phone:918-494-4945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK732103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical