Healthcare Provider Details

I. General information

NPI: 1174995179
Provider Name (Legal Business Name): THERAPEUTIC LIFE CHOICES TOHI USTI GVNVNV EDASDI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2015
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1728 S CARSON AVE
TULSA OK
74119-4610
US

IV. Provider business mailing address

401 S BOSTON AVE # 450-10
TULSA OK
74103-4016
US

V. Phone/Fax

Practice location:
  • Phone: 918-406-3420
  • Fax:
Mailing address:
  • Phone: 918-896-9688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRIS A. TAYLOR
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: BA; BHCM
Phone: 918-406-3420