Dr.G, PSYD, PLLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

1131 Issued in OK

Legal business name

DR.G, PSYD, PLLC

Practice address

1985 W 33Rd St
Edmond, OK 73013-3875

Phone

(405) 309-9051

NPI assigned

Oct 7, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Gricelda Fragoso, PSYD

Title

Owner

Phone

(405) 309-9051

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1412640000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412640000000",
    "number": "1861895625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1985 W 33RD ST",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730133875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1985 W 33RD ST",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730133875",
            "telephone_number": "405-309-9051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR.G, PSYD, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-07",
        "last_updated": "2014-10-07",
        "status": "A",
        "authorized_official_last_name": "FRAGOSO",
        "authorized_official_first_name": "GRICELDA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "405-309-9051",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "OK",
            "license": "1131",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Edmond, OK
• Providers in Edmond, OK by specialty
• Clinical Psychologist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 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.

Verify at the official NPI Registry.