Healthcare Provider Details

I. General information

NPI: 1821127325
Provider Name (Legal Business Name): MENTAL HEALTH ASSOCIATION IN TULSA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1870 S BOULDER AVE
TULSA OK
74119-5234
US

IV. Provider business mailing address

1870 S BOULDER AVE
TULSA OK
74119-5234
US

V. Phone/Fax

Practice location:
  • Phone: 918-585-1213
  • Fax: 918-585-1263
Mailing address:
  • Phone: 918-585-1213
  • Fax: 918-585-1263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. SUE A HORETH
Title or Position: CONTROLLER
Credential:
Phone: 918-382-2414