Healthcare Provider Details

I. General information

NPI: 1982270906
Provider Name (Legal Business Name): GAU Z VUE LMSW-P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 S BOSTON AVE STE 1
TULSA OK
74119-4029
US

IV. Provider business mailing address

1516 S BOSTON AVE STE 1
TULSA OK
74119-4029
US

V. Phone/Fax

Practice location:
  • Phone: 918-561-6000
  • Fax:
Mailing address:
  • Phone: 918-561-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number7930-P
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: