Healthcare Provider Details

I. General information

NPI: 1699534719
Provider Name (Legal Business Name): NURTURED IN NATURAL ENVIRONMENTS RANCH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2024
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 W 71ST ST
TULSA OK
74131-3459
US

IV. Provider business mailing address

4327 S ATLANTA AVE
TULSA OK
74105-4335
US

V. Phone/Fax

Practice location:
  • Phone: 918-934-4010
  • Fax:
Mailing address:
  • Phone: 918-934-4010
  • 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 Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FREDERICK LAWRENCE LOBPRIES
Title or Position: PRESIDENT, CO-FOUNDER
Credential:
Phone: 918-934-4010