Active NPI
Teri Leann Bourdeau, PH.D.
- Clinical Psychologist
- Tulsa, OK
National Provider Identifier
1811051238
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 1009
- Practice address
- 2345 Southwest Blvd
Tulsa, OK 74107-2705 - Phone
- (918) 561-8383
- Fax
- (918) 561-8546
- NPI assigned
- Dec 20, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 1009 | OK | Primary |
Addresses
Primary practice location
2345 Southwest Blvd
Tulsa, OK 74107-2705
Mailing address
2345 Southwest Blvd
Tulsa, OK 74107-2705
Phone (918) 561-8383
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200078120A | Medicaid | OK |
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1009 | OK | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166572800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1392854400000",
"number": "1811051238",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2345 SOUTHWEST BLVD",
"city": "TULSA",
"state": "OK",
"postal_code": "741072705",
"telephone_number": "918-561-8383",
"fax_number": "918-561-8546"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2345 SOUTHWEST BLVD",
"city": "TULSA",
"state": "OK",
"postal_code": "741072705",
"telephone_number": "918-561-8383",
"fax_number": "918-561-8546"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOURDEAU",
"first_name": "TERI",
"middle_name": "LEANN",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-20",
"last_updated": "2014-02-20",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OK",
"license": "1009",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200078120A",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tulsa, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.