Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 388 | OK |
Y | 103T00000X | Psychologist | 388 | OK |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 133 | OK |
NPI | 1326103086 |
---|---|
Provider Name | Ms. Judith Karen Adams |
First Address | Tulsa, OK 74146-3673 |
Second Address | Tulsa, OK 74146-3673 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/12/2006 |
Last Update Date | 21/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100842090A | (05) | OK |
100842090B | (05) | OK |
OK701157 | (02) |