Healthcare Provider Details

I. General information

NPI: 1336460443
Provider Name (Legal Business Name): TULSA ALLIANCE ON MENTAL ILLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2010
Last Update Date: 06/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S BOSTON AVE SUITE 219
TULSA OK
74119-1607
US

IV. Provider business mailing address

700 S BOSTON AVE SUITE 219
TULSA OK
74119-1607
US

V. Phone/Fax

Practice location:
  • Phone: 918-587-6264
  • Fax:
Mailing address:
  • Phone: 918-587-6264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: KENNETH C GUNNELLS
Title or Position: PRESIDENT
Credential:
Phone: 918-902-1712