Healthcare Provider Details

I. General information

NPI: 1386573079
Provider Name (Legal Business Name): AINSWORTH BEHAVIORAL HEALTH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5272 S LEWIS AVE STE 124
TULSA OK
74105-6544
US

IV. Provider business mailing address

PO BOX 66
GLENPOOL OK
74033-0066
US

V. Phone/Fax

Practice location:
  • Phone: 918-378-2752
  • Fax:
Mailing address:
  • Phone: 918-378-2752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: SHANNON R WEST
Title or Position: OWNER
Credential: LCSW
Phone: 918-378-2752