Healthcare Provider Details

I. General information

NPI: 1548422587
Provider Name (Legal Business Name): MISS SARA ERICKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2008
Last Update Date: 07/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7010 S YALE AVE STE 215
TULSA OK
74136-5743
US

IV. Provider business mailing address

7601 S 241ST EAST AVE
BROKEN ARROW OK
74014-2642
US

V. Phone/Fax

Practice location:
  • Phone: 918-492-2554
  • Fax: 918-494-9870
Mailing address:
  • Phone: 918-492-2554
  • Fax: 918-494-7098

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: