Healthcare Provider Details

I. General information

NPI: 1225622947
Provider Name (Legal Business Name): ELSA CHANTILE THOENE LADC/MH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2021
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6016 S 66TH EAST AVE
TULSA OK
74145-9210
US

IV. Provider business mailing address

4031 E 27TH ST
TULSA OK
74114-5942
US

V. Phone/Fax

Practice location:
  • Phone: 918-764-9098
  • Fax:
Mailing address:
  • Phone: 509-638-9294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1491
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: