Healthcare Provider Details

I. General information

NPI: 1225362577
Provider Name (Legal Business Name): SEMAH MALISSA YEKZAMAN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2009
Last Update Date: 09/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7010 S YALE AVE SUITE 215
TULSA OK
74136-5713
US

IV. Provider business mailing address

7010 S YALE AVE
TULSA OK
74136-5713
US

V. Phone/Fax

Practice location:
  • Phone: 918-492-2554
  • Fax: 918-494-9870
Mailing address:
  • Phone: 918-492-2554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: