Healthcare Provider Details

I. General information

NPI: 1093397838
Provider Name (Legal Business Name): RACHEL ANN LOONEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2021
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7806 E 108TH ST STE A
TULSA OK
74133-7414
US

IV. Provider business mailing address

504 W ATLANTA ST
BROKEN ARROW OK
74012-7004
US

V. Phone/Fax

Practice location:
  • Phone: 918-296-7746
  • Fax:
Mailing address:
  • Phone: 918-615-6620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11510
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: