Provider Demographics
NPI:1679519227
Name:SCRUGGS, JOE B III (PHD)
Entity type:Individual
Prefix:DR
First Name:JOE
Middle Name:B
Last Name:SCRUGGS
Suffix:III
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5110 S YALE AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-7401
Mailing Address - Country:US
Mailing Address - Phone:918-492-2385
Mailing Address - Fax:918-492-1579
Practice Address - Street 1:5110 S YALE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-7401
Practice Address - Country:US
Practice Address - Phone:918-492-2385
Practice Address - Fax:918-492-1579
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK737103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist