Healthcare Provider Details

I. General information

NPI: 1821635590
Provider Name (Legal Business Name): RACHEL RYCROFT LPC CANDIDATE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2019
Last Update Date: 12/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 S BOSTON AVE STE 1
TULSA OK
74119-4029
US

IV. Provider business mailing address

12302 S YUKON AVE APT 3434
GLENPOOL OK
74033-6659
US

V. Phone/Fax

Practice location:
  • Phone: 580-320-1150
  • Fax:
Mailing address:
  • Phone: 580-320-1150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: