Healthcare Provider Details

I. General information

NPI: 1265278485
Provider Name (Legal Business Name): LYFE STYLE CONSULTANT FIRM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 07/08/2024
Certification Date: 07/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7718 E 91ST ST STE 100
TULSA OK
74133-6051
US

IV. Provider business mailing address

8315 E 65TH ST
TULSA OK
74133-7610
US

V. Phone/Fax

Practice location:
  • Phone: 918-856-2557
  • Fax:
Mailing address:
  • Phone: 918-854-2557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. PRINCZ L JONES
Title or Position: OWNER
Credential: PH.D
Phone: 918-856-2557