Healthcare Provider Details

I. General information

NPI: 1205140175
Provider Name (Legal Business Name): NORTHTULSA COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2010
Last Update Date: 05/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 N PEORIA AVE
TULSA OK
74106-2512
US

IV. Provider business mailing address

PO BOX 480843
TULSA OK
74148-0843
US

V. Phone/Fax

Practice location:
  • Phone: 918-794-0197
  • Fax: 918-794-0196
Mailing address:
  • Phone: 918-794-0197
  • Fax: 918-794-0196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateOK

VIII. Authorized Official

Name: MS. SHELIA B. THOMPSON
Title or Position: PRESIDENT
Credential: LPC
Phone: 918-794-0197