Healthcare Provider Details

I. General information

NPI: 1164535167
Provider Name (Legal Business Name): MARK S SADLER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4520 S HARVARD AVE STE 200C
TULSA OK
74135-2925
US

IV. Provider business mailing address

4520 S HARVARD AVE STE 200C
TULSA OK
74135-2925
US

V. Phone/Fax

Practice location:
  • Phone: 918-743-3224
  • Fax: 918-743-9623
Mailing address:
  • Phone: 918-743-3224
  • Fax: 918-743-9623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number411
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: