Provider Demographics
NPI:1356915342
Name:PAUL G TOBIN PHD PROF CORP
Entity type:Organization
Organization Name:PAUL G TOBIN PHD PROF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:PAUL G TOBIN
Authorized Official - Middle Name:PHD
Authorized Official - Last Name:PSYCHOLOGIST
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:405-340-4321
Mailing Address - Street 1:3855 S BOULEVARD STE 100
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5499
Mailing Address - Country:US
Mailing Address - Phone:405-340-4321
Mailing Address - Fax:
Practice Address - Street 1:3855 S BOULEVARD STE 100
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-5499
Practice Address - Country:US
Practice Address - Phone:405-340-4321
Practice Address - Fax:405-340-9408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)