Healthcare Provider Details

I. General information

NPI: 1356552111
Provider Name (Legal Business Name): PARKSIDE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1239 S TRENTON AVE
TULSA OK
74120-5420
US

IV. Provider business mailing address

1239 S TRENTON AVE
TULSA OK
74120-5420
US

V. Phone/Fax

Practice location:
  • Phone: 918-582-2131
  • Fax: 918-588-8822
Mailing address:
  • Phone: 918-582-2131
  • Fax: 918-588-8822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number2261
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number2261
License Number StateOK

VIII. Authorized Official

Name: MR. WILLIAM ERIC SACHAU
Title or Position: EXEC. DIRECTOR ADMIN SVCS.
Credential:
Phone: 918-582-2131