Healthcare Provider Details

I. General information

NPI: 1376845578
Provider Name (Legal Business Name): CAPES CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2010
Last Update Date: 11/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5350 E 46TH ST SUITE 110
TULSA OK
74135-6612
US

IV. Provider business mailing address

3311 E 46TH ST
TULSA OK
74135-2903
US

V. Phone/Fax

Practice location:
  • Phone: 918-747-8282
  • Fax: 918-747-6601
Mailing address:
  • Phone: 918-747-8282
  • Fax: 918-747-6601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. MARY ELIZABETH RINEER
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 918-747-8282