Basic Information
Provider Information
NPI: 1841579166
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PASTERNIK
FirstName: FRANCES
MiddleName: BERNICE
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2220 N CLASSEN BLVD
Address2: SUITE E
City: OKLAHOMA CITY
State: OK
PostalCode: 731065809
CountryCode: US
TelephoneNumber: 4055281748
FaxNumber: 4055281802
Practice Location
Address1: 2220 NORTH CLASSEN BLVD
Address2: SUITE E
City: OKLAHOMA CITY
State: OK
PostalCode: 73106
CountryCode: US
TelephoneNumber: 4055281748
FaxNumber: 4055281802
Other Information
ProviderEnumerationDate: 08/04/2011
LastUpdateDate: 03/20/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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