Provider Demographics
NPI:1295757128
Name:KRANAU, EDGAR JULIAN (PH D)
Entity type:Individual
Prefix:
First Name:EDGAR
Middle Name:JULIAN
Last Name:KRANAU
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14082
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74159-1082
Mailing Address - Country:US
Mailing Address - Phone:918-712-9020
Mailing Address - Fax:918-712-9021
Practice Address - Street 1:6216 S LEWIS AVE
Practice Address - Street 2:SUITE 164
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-1044
Practice Address - Country:US
Practice Address - Phone:918-712-9020
Practice Address - Fax:918-712-9021
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK434103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist