Organization
DIANE C.KIRK, PSY.D, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DIANE C KIRK PSY.D. (CLINICAL PSYCHOLOGIST)
(302) 545-5353
Entity
Organization
Contact information
Practice address
3010 S HARVARD AVE, SUITE 110, TULSA, OK 74114-6124
(302) 545-5353
Mailing address
1616 E 32ND PL, TULSA, OK 74105-2117
(302) 545-5353
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1234
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200594670A
—
OK
Enumeration date
08/11/2016
Last updated
08/11/2016
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