Healthcare Provider Details

I. General information

NPI: 1235518408
Provider Name (Legal Business Name): ANDREA MONIZ M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2015
Last Update Date: 05/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4122 W 55TH PL
TULSA OK
74107-9108
US

IV. Provider business mailing address

5606 S 82ND EAST AVE
TULSA OK
74145-7926
US

V. Phone/Fax

Practice location:
  • Phone: 918-486-9996
  • Fax: 800-260-7966
Mailing address:
  • Phone: 808-205-9258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: