Healthcare Provider Details

I. General information

NPI: 1295342046
Provider Name (Legal Business Name): INTEGRATIVE HEALTHCARE SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2020
Last Update Date: 09/25/2020
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2227 E 8TH ST
TULSA OK
74104-3237
US

IV. Provider business mailing address

2227 E 8TH ST
TULSA OK
74104-3237
US

V. Phone/Fax

Practice location:
  • Phone: 567-208-0581
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code374T00000X
TaxonomyReligious Nonmedical Nursing Personnel
License Number
License Number State

VIII. Authorized Official

Name: SARAH RAY
Title or Position: CEO/FOUNDER
Credential: RN
Phone: 567-208-0581