Provider Demographics
NPI:1609331230
Name:SECOR, SCOTT PAUL (PSYCHOLOGIST)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:PAUL
Last Name:SECOR
Suffix:
Gender:M
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4107 N COUNCIL RD STE C1
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-3138
Mailing Address - Country:US
Mailing Address - Phone:405-628-9345
Mailing Address - Fax:
Practice Address - Street 1:4107 N COUNCIL RD STE C1
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-3138
Practice Address - Country:US
Practice Address - Phone:405-628-9345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-07
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5439101YM0800X
OK1350103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health