Healthcare Provider Details

I. General information

NPI: 1174347215
Provider Name (Legal Business Name): LEAH NATASHA MITCHELL CDSVRP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3124 E APACHE ST
TULSA OK
74110-2320
US

IV. Provider business mailing address

3124 E APACHE ST
TULSA OK
74110-2320
US

V. Phone/Fax

Practice location:
  • Phone: 918-743-5763
  • Fax:
Mailing address:
  • Phone: 918-743-5763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: