Healthcare Provider Details

I. General information

NPI: 1790246619
Provider Name (Legal Business Name): TULSA FAMILY PSYCHIATRY & WELLNESS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2526 E 71ST ST STE J
TULSA OK
74136-5576
US

IV. Provider business mailing address

2526 E 71ST ST STE J
TULSA OK
74136-5576
US

V. Phone/Fax

Practice location:
  • Phone: 918-268-9578
  • Fax: 918-471-2854
Mailing address:
  • Phone: 918-268-9578
  • Fax: 918-471-2854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: SCOTT M FISHER
Title or Position: CEO
Credential: MHA
Phone: 918-268-9578