Healthcare Provider Details

I. General information

NPI: 1700074630
Provider Name (Legal Business Name): ST PIUS X CHURCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7512 E 19TH ST
TULSA OK
74112-7704
US

IV. Provider business mailing address

7512 E 19TH ST
TULSA OK
74112-7704
US

V. Phone/Fax

Practice location:
  • Phone: 918-622-4488
  • Fax:
Mailing address:
  • Phone: 918-622-4488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateOK

VIII. Authorized Official

Name: KELLI M ERWIN
Title or Position: THERAPIST
Credential: LPC
Phone: 918-622-4488