Healthcare Provider Details

I. General information

NPI: 1811228471
Provider Name (Legal Business Name): ERIN MUSGRAVE ERIN MUSGRAVE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2010
Last Update Date: 01/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 S BOSTON AVE STE 100
TULSA OK
74119-4003
US

IV. Provider business mailing address

1516 S BOSTON AVE SUITE 100
TULSA OK
74119
US

V. Phone/Fax

Practice location:
  • Phone: 918-561-6000
  • Fax:
Mailing address:
  • Phone: 918-907-1187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: