Provider Demographics
NPI:1649365966
Name:FORDUCEY, PAMELA GAYLE (PHD)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:GAYLE
Last Name:FORDUCEY
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 1:2717 NW 55TH PL
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-7010
Mailing Address - Country:US
Mailing Address - Phone:405-608-3060
Mailing Address - Fax:
Practice Address - Street 1:5400 N INDEPENDENCE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-5300
Practice Address - Country:US
Practice Address - Phone:405-713-4433
Practice Address - Fax:405-951-8851
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK590103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist