Basic Information
| Provider Information | |||||||||
| NPI: | 1124355805 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HILDESTAD | ||||||||
| FirstName: | PAULA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 407 WILL ROGERS LOOP E | ||||||||
| Address2: | |||||||||
| City: | OOLOGAH | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740536211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186251458 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7010 S YALE AVE STE 215 | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741365743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184922554 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2009 | ||||||||
| LastUpdateDate: | 11/17/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TH0100X | Y | Behavioral Health & Social Service Providers | Psychologist | Health Service |
No ID Information.