Organization
DR.G, PSYD, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRICELDA FRAGOSO PSYD (OWNER)
(405) 309-9051
Entity
Organization
Contact information
Practice address
1985 W 33RD ST, EDMOND, OK 73013-3875
(405) 309-9051
Mailing address
1985 W 33RD ST, EDMOND, OK 73013-3875
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1131
OK
Other
Enumeration date
10/07/2014
Last updated
10/07/2014
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