Healthcare Provider Details

I. General information

NPI: 1740931609
Provider Name (Legal Business Name): SENIOR PSYCHOLOGICAL CARE OF OKLAHOMA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2022
Last Update Date: 01/12/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6202 E 61ST ST
TULSA OK
74136-2119
US

IV. Provider business mailing address

4635 SOUTHWEST FWY STE 635
HOUSTON TX
77027-7112
US

V. Phone/Fax

Practice location:
  • Phone: 713-850-0049
  • Fax:
Mailing address:
  • Phone: 713-850-0049
  • Fax: 713-627-7302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: RANDALL J. FRAPART
Title or Position: COO/CFO
Credential: CPA
Phone: 713-850-0049