Healthcare Provider Details

I. General information

NPI: 1093600298
Provider Name (Legal Business Name): JILLIAN ZAVACKY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2025
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 N GILCREASE MUSEUM RD
TULSA OK
74127-2101
US

IV. Provider business mailing address

1616 N GILCREASE MUSEUM RD
TULSA OK
74127-2101
US

V. Phone/Fax

Practice location:
  • Phone: 405-530-2078
  • Fax:
Mailing address:
  • Phone: 405-530-2078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number21737-P
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: