Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 714 | OK |
N | 103T00000X | Psychologist | 714 | OK |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 714 | OK |
N | 103G00000X | Clinical Psychologist | 714 | OK |
N | 103TC0700X | Clinical Psychologist | 714 | OK |
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 714 | OK |
N | 103TM1800X | Intellectual & Developmental Disabilities | 714 | OK |
NPI | 1104850346 |
---|---|
Provider Name | Dr. Krikor B Garabedian |
First Address | Stillwater, OK 74074-4635 |
Second Address | Stillwater, OK 74074-4635 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 19/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100631500B | (05) | OK |
100631500C | (05) | OK |