Provider Demographics
NPI:1457396210
Name:AHLUWALIA, EKTA W (PHD)
Entity Type:Individual
Prefix:
First Name:EKTA
Middle Name:W
Last Name:AHLUWALIA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9641 CASTLE RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-7217
Mailing Address - Country:US
Mailing Address - Phone:405-721-0168
Mailing Address - Fax:
Practice Address - Street 1:9641 CASTLE RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-7217
Practice Address - Country:US
Practice Address - Phone:405-721-0168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK673103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK445401657-002OtherBC/BS
OK100676600BMedicaid