Healthcare Provider Details

I. General information

NPI: 1497535249
Provider Name (Legal Business Name): LEILA M NOVELO MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2023
Last Update Date: 09/29/2023
Certification Date: 09/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6216 S LEWIS AVE STE 180
TULSA OK
74136-1077
US

IV. Provider business mailing address

6216 S LEWIS AVE STE 180
TULSA OK
74136-1077
US

V. Phone/Fax

Practice location:
  • Phone: 918-960-7852
  • Fax: 539-664-5738
Mailing address:
  • Phone: 918-960-7852
  • Fax: 539-664-5738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5229
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: