Healthcare Provider Details

I. General information

NPI: 1598486524
Provider Name (Legal Business Name): CALLA BOEWE-CUFF LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CALLA WEISE

II. Dates (important events)

Enumeration Date: 09/07/2022
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6440 S LEWIS AVE STE 2200
TULSA OK
74136-1060
US

IV. Provider business mailing address

408 S INDIANWOOD AVE
BROKEN ARROW OK
74012-3231
US

V. Phone/Fax

Practice location:
  • Phone: 918-712-0859
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number20229-P
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number22826
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: