Healthcare Provider Details

I. General information

NPI: 1831053131
Provider Name (Legal Business Name): MOSAIC FAMILY THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6711 S YALE AVE STE 106
TULSA OK
74136-3317
US

IV. Provider business mailing address

12515 E 134TH ST S
BROKEN ARROW OK
74011-7437
US

V. Phone/Fax

Practice location:
  • Phone: 918-606-1314
  • Fax: 539-233-1536
Mailing address:
  • Phone: 918-606-1314
  • Fax: 539-233-1536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. LESLIE KEENAN
Title or Position: OWNER
Credential: LMFT
Phone: 918-606-1314