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General NPI Number Information
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NPI Number | 1154669828
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Entity Type | Organization
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Legal Business Name | SYDLYFE COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 01/30/2013
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Last Update Date | 04/10/2019
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Provider Practice Location Address
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Address Line | 3606 N MLK BLV JR.
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City | TULSA
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State | OK
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Zip | 74106-1700
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Country | US
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Telephone | 918-231-0684
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 48646
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City | TULSA
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State | OK
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Zip | 74148-0646
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Country | US
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Telephone | 918-231-0684
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. NORRIS V SCOTT
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Credential | MASTERS
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Telephone | 918-231-0684
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | OK
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