Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 1291 | OK |
NPI | 1083132344 |
---|---|
Provider Name | Dr. Craigery Bryant Cruzan |
First Address | Norman, OK 73019-3142 |
Second Address | Norman, OK 73019-3142 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2017 |
Last Update Date | 06/09/2017 |