Healthcare Provider Details

I. General information

NPI: 1063623833
Provider Name (Legal Business Name): STUART HOLDERNESS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 09/12/2024
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7151 S BRADEN AVE
TULSA OK
74136
US

IV. Provider business mailing address

7151 S BRADEN AVE
TULSA OK
74136
US

V. Phone/Fax

Practice location:
  • Phone: 918-499-0300
  • Fax: 918-499-0357
Mailing address:
  • Phone: 918-499-0300
  • Fax: 918-499-0357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. STUART L HOLDERNESS
Title or Position: OWNER
Credential: PH.D.
Phone: 918-499-0300