Provider Demographics
NPI:1255966941
Name:ST. DYMPHNA PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:ST. DYMPHNA PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:FLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:405-445-0005
Mailing Address - Street 1:3030 NW EXPRESSWAY STE 300
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5400
Mailing Address - Country:US
Mailing Address - Phone:405-445-0005
Mailing Address - Fax:405-842-0079
Practice Address - Street 1:3030 NW EXPRESSWAY STE 300
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-5400
Practice Address - Country:US
Practice Address - Phone:405-445-0005
Practice Address - Fax:405-842-0079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-03
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200898780AMedicaid