Healthcare Provider Details

I. General information

NPI: 1720485220
Provider Name (Legal Business Name): KEYSTONE COUNSELING AND THERAPEUTIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2014
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6202 S LEWIS AVE STE A1
TULSA OK
74136-1099
US

IV. Provider business mailing address

6202 S LEWIS AVE STE A1
TULSA OK
74136-1099
US

V. Phone/Fax

Practice location:
  • Phone: 918-261-1129
  • Fax:
Mailing address:
  • Phone: 918-261-1129
  • Fax:

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. ANNETTE EVONNE SHAEFFER
Title or Position: EXECUTIVE DIRECTOR
Credential: MS, LPC
Phone: 918-261-1129