Basic Information
| Provider Information | |||||||||
| NPI: | 1568720951 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PSYCHIATRY AND PSYCHOTHERAPY OF CENTRAL OKLAHOMA, PLLC | ||||||||
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| OtherOrganizationName: | OKLAHOMA BEHAVIORAL HEALTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2301 W I 44 SERVICE RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731128729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056072233 | ||||||||
| FaxNumber: | 4052861303 | ||||||||
| Practice Location | |||||||||
| Address1: | 2301 W I 44 SERVICE RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731128729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056072233 | ||||||||
| FaxNumber: | 4052861303 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2012 | ||||||||
| LastUpdateDate: | 03/05/2015 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | PEYTON | ||||||||
| AuthorizedOfficialFirstName: | MARVIN | ||||||||
| AuthorizedOfficialMiddleName: | LANE | ||||||||
| AuthorizedOfficialTitleorPosition: | PSYCHIATRIST | ||||||||
| AuthorizedOfficialTelephone: | 4056072233 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PSYCHIATRY AND PSYCHOTHERAPY OF CENTRAL OKLAHOMA, PLLC | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | OK24005 | OK | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.