Healthcare Provider Details

I. General information

NPI: 1275352494
Provider Name (Legal Business Name): TULSA PSYCHOTHERAPY COLLECTIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2024
Last Update Date: 10/04/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4606 E 26TH STREET
TULSA OK
74114
US

IV. Provider business mailing address

1611 S UTICA AVE # 315
TULSA OK
74104-4909
US

V. Phone/Fax

Practice location:
  • Phone: 918-809-8986
  • Fax:
Mailing address:
  • Phone: 918-809-8986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CAITLIN AKEMAN
Title or Position: DIRECTOR OF OPERATIONS
Credential: MS, LPC
Phone: 918-809-8986