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NPI Code Detail

MEDICARE: MR. JOSH JORDAN BEAVERS

MEDICARE: MR. JOSH JORDAN BEAVERS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1154717460
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOSH JORDAN BEAVERS
Provider Business Mailing Address
First Line : 2448 E 81ST ST STE 5100
Second Line :
City : TULSA
State : OK
Zip : 74137-4289
Country : US
Telephone Number : 405-822-7635
Fax Number :
Provider Business Practice Location Address
First Line : 2448 E 81ST ST STE 5100
Second Line :
City : TULSA
State : OK
Zip : 74137-4289
Country : US
Telephone Number : 405-822-7635
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2015
Last Update Date : 09/12/2023

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Directions to “ MR. JOSH JORDAN BEAVERS ” Practice Location

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