Healthcare Provider Details

I. General information

NPI: 1720918790
Provider Name (Legal Business Name): TULSA GRIEF AND COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6846 S CANTON AVE STE 520Q
TULSA OK
74136-3417
US

IV. Provider business mailing address

745 E 42ND PL N
TULSA OK
74106-1317
US

V. Phone/Fax

Practice location:
  • Phone: 918-851-8824
  • Fax: 918-796-2777
Mailing address:
  • Phone: 918-851-8824
  • Fax: 918-796-2777

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: IKIA KHALIL YOUNG
Title or Position: OWNER / THERAPIST
Credential: LPC-S
Phone: 918-851-8824