Healthcare Provider Details

I. General information

NPI: 1104138510
Provider Name (Legal Business Name): MRS. SAMANTHA GAIL MORRIS MCKNIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2010
Last Update Date: 07/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 E SKELLY DR SUITE 103
TULSA OK
74105-6317
US

IV. Provider business mailing address

321 NW 3RD ST
PERKINS OK
74059-3615
US

V. Phone/Fax

Practice location:
  • Phone: 918-388-6457
  • Fax:
Mailing address:
  • Phone: 405-385-1249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: