Healthcare Provider Details

I. General information

NPI: 1972117356
Provider Name (Legal Business Name): MARY PRISCA ELEANYA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2020
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 S LEWIS AVE STE 100
TULSA OK
74136-1019
US

IV. Provider business mailing address

6400 S LEWIS AVE STE 100
TULSA OK
74136-1019
US

V. Phone/Fax

Practice location:
  • Phone: 405-378-2727
  • Fax:
Mailing address:
  • Phone: 405-378-2727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number102227
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number22288
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number109137
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: