Active NPI
Caleb Wayne Lack, PH.D.
- Clinical Psychologist
- Edmond, OK
National Provider Identifier
1003074741
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 1143
- Practice address
- 7413 Oak Ave
Edmond, OK 73034-9058 - Phone
- (405) 509-0959
- NPI assigned
- May 29, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 07-37P | AR | |
| Clinical Psychologist | 103TC0700X | 1143 | OK | Primary |
Addresses
Primary practice location
7413 Oak Ave
Edmond, OK 73034-9058
Mailing address
7413 Oak Ave
Edmond, OK 73034-9058
Phone (405) 509-0959
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 07-37P | AR | MD | Clinical Psychologist |
| 1143 | OK | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1212019200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521590400000",
"number": "1003074741",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7413 OAK AVE",
"city": "EDMOND",
"state": "OK",
"postal_code": "730349058",
"telephone_number": "405-509-0959"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7413 OAK AVE",
"city": "EDMOND",
"state": "OK",
"postal_code": "730349058",
"telephone_number": "405-509-0959"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LACK",
"first_name": "CALEB",
"middle_name": "WAYNE",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-05-29",
"last_updated": "2018-03-21",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "AR",
"license": "07-37P",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OK",
"license": "1143",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Edmond, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.