Healthcare Provider Details

I. General information

NPI: 1073787404
Provider Name (Legal Business Name): PATRICE D. RILEY MHR/MRC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PAT D SIMPKINS MHR/MRC

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

448 36TH AVE NW STE 101
NORMAN OK
73072-4743
US

IV. Provider business mailing address

4528 S SHERIDAN RD STE 113 4528 S. SHERIDAN RD, STE 113, TULSA OK 74145
TULSA OK
74145-1101
US

V. Phone/Fax

Practice location:
  • Phone: 888-573-7792
  • Fax:
Mailing address:
  • Phone: 918-282-5363
  • Fax: 918-282-5363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number21448
License Number StateOK
# 6
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: