MEDICARE: FAITH HEALTH CENTER, 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
1	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1336811041
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAITH HEALTH CENTER, LLC

Provider Business Mailing Address
First Line	:	PO BOX 311
Second Line	:
City	:	JENKS
State	:	OK
Zip	:	74037-0311
Country	:	US
Telephone Number	:	918-876-0606
Fax Number	:	918-876-0604

Provider Business Practice Location Address
First Line	:	6846 S CANTON AVE STE 230
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-3420
Country	:	US
Telephone Number	:	918-876-0606
Fax Number	:	918-876-0604

Authorized Official
Title or Position	:	OWNER
Name	:	JUDY WAGGA
Credential	:	PMHNP
Telephone Number	:	918-876-0606

Provider Enumeration Date	:	09/30/2021
Last Update Date	:	05/18/2026

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Directions to “FAITH HEALTH CENTER, LLC ” Practice Location

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