Healthcare Provider Details

I. General information

NPI: 1619586260
Provider Name (Legal Business Name): TESSELA SHANISE GARRETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2020
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7711 E 111TH ST STE 109
TULSA OK
74133-2562
US

IV. Provider business mailing address

1338 E 60TH ST APT 6P
TULSA OK
74105-8584
US

V. Phone/Fax

Practice location:
  • Phone: 918-928-5437
  • Fax:
Mailing address:
  • Phone: 918-981-7017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2848795
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: