1053650903 NPI number — PSYCHOLOGICAL SERVICES, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053650903 NPI number — PSYCHOLOGICAL SERVICES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PSYCHOLOGICAL SERVICES, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MICHAEL LOCK, PH.D.
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053650903
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/16/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4815 S HARVARD AVE
Provider Second Line Business Mailing Address:
SUITE 250
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74135-3060
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-804-7561
Provider Business Mailing Address Fax Number:
918-392-4845

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4815 S HARVARD AVE
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74135-3060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-804-7561
Provider Business Practice Location Address Fax Number:
918-392-4845
Provider Enumeration Date:
02/12/2013

Additional Information

Authorized Official

Authorized Official Last Name:
LOCK
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER/PHYSICIAN
Authorized Official Telephone Number:
918-804-7561

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  611 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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