Healthcare Provider Details

I. General information

NPI: 1720328545
Provider Name (Legal Business Name): BEHAVIORAL HEALTH AFFILIATES OF TULSA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2013
Last Update Date: 02/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7146 S BRADEN AVE SUITE 500
TULSA OK
74136-6371
US

IV. Provider business mailing address

7146 S BRADEN AVE SUITE 500
TULSA OK
74136-6371
US

V. Phone/Fax

Practice location:
  • Phone: 918-488-6165
  • Fax:
Mailing address:
  • Phone: 918-488-6165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1600
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number566
License Number StateOK

VIII. Authorized Official

Name: DR. JANET WILLIS
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 918-488-6165