Healthcare Provider Details

I. General information

NPI: 1679496657
Provider Name (Legal Business Name): TERESA COLLINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 S ELM PL STE 106
BROKEN ARROW OK
74012-5369
US

IV. Provider business mailing address

7711 E 111TH ST STE 111
TULSA OK
74133-2563
US

V. Phone/Fax

Practice location:
  • Phone: 918-727-2928
  • Fax: 918-727-2928
Mailing address:
  • Phone: 918-727-2928
  • Fax: 918-727-2928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: