Healthcare Provider Details

I. General information

NPI: 1679764807
Provider Name (Legal Business Name): RIVERSIDE COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 11/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5272 S LEWIS AVE STE 250
TULSA OK
74105-6564
US

IV. Provider business mailing address

5272 S. LEWIS SUITE 250
TULSA OK
74066
US

V. Phone/Fax

Practice location:
  • Phone: 918-524-3300
  • Fax:
Mailing address:
  • Phone: 918-524-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number282
License Number StateOK

VIII. Authorized Official

Name: DR. JOSEPH M SCHWARTZ
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 918-524-3300