Healthcare Provider Details

I. General information

NPI: 1891296836
Provider Name (Legal Business Name): AWS BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2018
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5424 N. MADISON AVE
TULSA OK
74126-9999
US

IV. Provider business mailing address

5424 N. MADISON AVE
TULSA OK
74126-0000
US

V. Phone/Fax

Practice location:
  • Phone: 918-221-6042
  • Fax: 918-221-6042
Mailing address:
  • Phone: 918-221-6042
  • Fax: 918-221-6042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: PRECIOUS CLARDY III
Title or Position: ADMIN/CEO
Credential: LPC
Phone: 918-853-9700