Provider Demographics
NPI:1184897506
Name:LESLEY J DLUGOKINSKI PHD
Entity type:Organization
Organization Name:LESLEY J DLUGOKINSKI PHD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:DLUGOKINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:405-848-7321
Mailing Address - Street 1:5956 NW 71ST ST
Mailing Address - Street 2:
Mailing Address - City:WARR ACRES
Mailing Address - State:OK
Mailing Address - Zip Code:73132-6518
Mailing Address - Country:US
Mailing Address - Phone:405-848-7321
Mailing Address - Fax:
Practice Address - Street 1:5956 NW 71ST ST
Practice Address - Street 2:
Practice Address - City:WARR ACRES
Practice Address - State:OK
Practice Address - Zip Code:73132-6518
Practice Address - Country:US
Practice Address - Phone:405-848-7321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK488103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100842440AMedicaid
OK242415500Medicare PIN