Healthcare Provider Details

I. General information

NPI: 1649912783
Provider Name (Legal Business Name): CHANGAI LI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2022
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6216 S LEWIS AVE
TULSA OK
74136-1044
US

IV. Provider business mailing address

8131 S 77TH EAST AVE APT N107
TULSA OK
74133-3912
US

V. Phone/Fax

Practice location:
  • Phone: 918-812-7983
  • Fax:
Mailing address:
  • Phone: 918-812-7983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPCCANDIDATE12943
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: