Organization
GRUNDY PSYCHOLOGICAL SERVICES, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELIZABETH MOLLETTE GRUNDY PH.D. (VICE PRESIDENT)
(918) 855-8315
Entity
Organization
Contact information
Practice address
205 KETCHUM AVENUE, KETCHUM, OK 74349
(918) 629-8664
(918) 782-4301
Mailing address
PO BOX 6, KETCHUM, OK 74349-0006
(918) 629-8664
(918) 782-4301
Taxonomy
Speciality
Code
Description
License number
State
103TH0100X
Health Service Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100838100A
—
OK
05
—
100839060A
—
OK
Enumeration date
10/22/2018
Last updated
10/22/2018
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