Provider Demographics
NPI:1548096324
Name:RALSTIN, AUSTIN DIWIGHT (PSYD)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:DIWIGHT
Last Name:RALSTIN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE
Mailing Address - State:OK
Mailing Address - Zip Code:73044-3324
Mailing Address - Country:US
Mailing Address - Phone:405-757-1793
Mailing Address - Fax:
Practice Address - Street 1:712 WALL ST STE 100
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6360
Practice Address - Country:US
Practice Address - Phone:405-579-7560
Practice Address - Fax:405-579-7563
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist