Healthcare Provider Details

I. General information

NPI: 1487191748
Provider Name (Legal Business Name): D'ANDRIA CROOMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2017
Last Update Date: 01/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 N GREENWOOD AVE 305
TULSA OK
74120-1443
US

IV. Provider business mailing address

426 S 77TH EAST AVE
TULSA OK
74112-2126
US

V. Phone/Fax

Practice location:
  • Phone: 918-794-9696
  • Fax: 918-794-9622
Mailing address:
  • Phone: 918-720-9863
  • Fax: 918-794-9622

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: