Healthcare Provider Details

I. General information

NPI: 1922440171
Provider Name (Legal Business Name): TULSA CENTER FOR BEHAVIOUR HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2013
Last Update Date: 07/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 S HARVARD AVE
TULSA OK
74114-3301
US

IV. Provider business mailing address

10426 E 42ND ST LOT 217
TULSA OK
74146-3744
US

V. Phone/Fax

Practice location:
  • Phone: 918-378-0359
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: JESSICA RILEY
Title or Position: CRS
Credential:
Phone: 918-378-0359