| Dr. Alice Wellington, Ph.d., Pllc | |
|
119 S Broadway Edmond OK 73034-3843 | |
| (405) 474-4151 | |
| (405) 330-2938 |
| Full Name | Dr. Alice Wellington, Ph.d., Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 119 S Broadway, Edmond, Oklahoma |
| Authorized Official Name and Position | Alice Janine Wellington (CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 4054744151 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr. Alice Wellington, Ph.d., Pllc 119 S Broadway Edmond OK 73034-3843 Ph: (405) 474-4151 | Dr. Alice Wellington, Ph.d., Pllc 119 S Broadway Edmond OK 73034-3843 Ph: (405) 474-4151 |
| NPI Number | 1235568411 |
|---|---|
| Provider Enumeration Date | 11/07/2013 |
| Last Update Date | 11/07/2013 |
| Medicare PECOS PAC ID | 7113155342 |
|---|---|
| Medicare Enrollment ID | O20140116000460 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235568411 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 610 (Oklahoma) | Primary |
| Provider Name | Alice J Wellington |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1396084968 PECOS PAC ID: 8022246255 Enrollment ID: I20141003002022 |
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