Healthcare Provider Details

I. General information

NPI: 1386767820
Provider Name (Legal Business Name): TANYA JOLENE SKOTAREK TUFFOUR MS, LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 08/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S. PITTSBURG AVE
TULSA OK
74112
US

IV. Provider business mailing address

501 S PITTSBURG AVE
TULSA OK
74112-1203
US

V. Phone/Fax

Practice location:
  • Phone: 918-740-9667
  • Fax:
Mailing address:
  • Phone: 918-740-9667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number848
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: