Healthcare Provider Details

I. General information

NPI: 1588875355
Provider Name (Legal Business Name): FAMILY-INTEGRATED THERAPY SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 03/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4870 S LEWIS AVE SUITE 245
TULSA OK
74105-5151
US

IV. Provider business mailing address

4870 S LEWIS AVE SUITE 245
TULSA OK
74105-5151
US

V. Phone/Fax

Practice location:
  • Phone: 918-850-7465
  • Fax: 918-779-4571
Mailing address:
  • Phone: 918-850-7465
  • Fax: 918-779-4571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number421
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number421
License Number StateOK

VIII. Authorized Official

Name: MS. JANET HARROD CARR
Title or Position: OWNER, SPEECH-LANGUAGE PATHOLOGIST
Credential: M.A., CCC SLP
Phone: 918-850-7465