Healthcare Provider Details

I. General information

NPI: 1598521064
Provider Name (Legal Business Name): MRS. ANGELA SUE SOLANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2024
Last Update Date: 02/23/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3124 E APACHE ST
TULSA OK
74110-2320
US

IV. Provider business mailing address

4540 S 28TH WEST AVE
TULSA OK
74107-6644
US

V. Phone/Fax

Practice location:
  • Phone: 918-508-2733
  • Fax:
Mailing address:
  • Phone: 918-804-3263
  • Fax: 918-744-4432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCCANDIDATE12048
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: