=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063650778
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALLIANCE OF TULSA INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2009
-----------------------------------------------------
Last Update Date | 02/03/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5215 E 71ST ST SUITE 1400
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74136-6341
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-747-0155
-----------------------------------------------------
Fax | 918-747-0159
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5215 E 71ST ST SUITE 1400
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74136-6341
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-747-0155
-----------------------------------------------------
Fax | 918-747-0159
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. JAMES DALE LOVETT
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 918-747-0155
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 3896
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------