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General NPI Number Information
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NPI Number | 1124557426
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Entity Type | Organization
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Legal Business Name | STATE OF OKLAHOMA - OSU CENTER FOR HEALTH SCIENCE COLLEGE OF OSTEOPATH
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Dates
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Enumeration Date | 06/08/2017
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 5310 E 31ST ST STE LL
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City | TULSA
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State | OK
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Zip | 74135-5013
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Country | US
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Telephone | 918-236-4000
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Fax | 918-236-4001
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Provider Business Mailing Address
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Address Line | 5310 E 31ST ST STE 13
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City | TULSA
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State | OK
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Zip | 74135-5013
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Country | US
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Telephone | 918-561-5701
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Fax | 918-561-1173
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Authorized Official
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Title or Position | VP FOR ADMINISTRATION & FINANCE
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Name | ERIC POLAK
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Credential |
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Telephone | 918-561-8422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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