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NPI Code Detail

MEDICARE: THERAPEUTIC LIFE CHOICES TOHI USTI GVNVNV EDASDI LLC

MEDICARE: THERAPEUTIC LIFE CHOICES TOHI USTI GVNVNV EDASDI LLC
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
1251B00000XCase Management Agency
2251S00000XCommunity/Behavioral Health Agency
3175T00000XPeer Specialist
4261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1174995179
Entity Type Code : Organization
Provider Name (Legal Business Name) : THERAPEUTIC LIFE CHOICES TOHI USTI GVNVNV EDASDI LLC
Provider Business Mailing Address
First Line : 401 S BOSTON AVE # 450-10
Second Line :
City : TULSA
State : OK
Zip : 74103-4016
Country : US
Telephone Number : 918-896-9688
Fax Number :
Provider Business Practice Location Address
First Line : 1728 S CARSON AVE
Second Line :
City : TULSA
State : OK
Zip : 74119-4610
Country : US
Telephone Number : 918-406-3420
Fax Number :
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : MR. CHRIS A. TAYLOR
Credential : BA; BHCM
Telephone Number : 918-406-3420
Provider Enumeration Date : 10/29/2015
Last Update Date : 10/22/2025

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