Grundy Psychological Services, P.c. | |
205 Ketchum Avenue Ketchum OK 74349 | |
(918) 629-8664 | |
(918) 782-4301 |
Full Name | Grundy Psychological Services, P.c. |
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Speciality | Psychologist - Health Service |
Location | 205 Ketchum Avenue, Ketchum, Oklahoma |
Authorized Official Name and Position | Elizabeth Mollette Grundy (VICE PRESIDENT) |
Authorized Official Contact | 9188558315 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Grundy Psychological Services, P.c. Po Box 6 Ketchum OK 74349-0006 Ph: (918) 629-8664 | Grundy Psychological Services, P.c. 205 Ketchum Avenue Ketchum OK 74349 Ph: (918) 629-8664 |
NPI Number | 1457827016 |
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Provider Enumeration Date | 10/22/2018 |
Last Update Date | 10/22/2018 |
Identifier | Type | State | Issuer |
---|---|---|---|
1457827016 | NPI | - | NPPES |
100839060A | Medicaid | OK | |
100838100A | Medicaid | OK |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103TH0100X | Psychologist - Health Service | (* (Not Available)) | Primary |