Healthcare Provider Details

I. General information

NPI: 1720786080
Provider Name (Legal Business Name): VIRTUAL SERVICE DOG SUPPORTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2023
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3228 S JAMESTOWN AVE
TULSA OK
74135-4408
US

IV. Provider business mailing address

3228 S JAMESTOWN AVE
TULSA OK
74135-4408
US

V. Phone/Fax

Practice location:
  • Phone: 918-280-9320
  • Fax: 918-221-8079
Mailing address:
  • Phone: 918-280-9320
  • Fax: 918-221-8079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name: PAMELA GUENTHER
Title or Position: MANAGING MEMBER
Credential:
Phone: 918-280-9320