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General NPI Number Information
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NPI Number | 1194405704
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Entity Type | Organization
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Legal Business Name | FULL LIFE BEHAVIORAL SYSTEMS, INC.
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Dates
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Enumeration Date | 07/19/2023
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Last Update Date | 07/19/2023
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Provider Practice Location Address
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Address Line | 3015 E SKELLY DR STE 135
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City | TULSA
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State | OK
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Zip | 74105-6344
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Country | US
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Telephone | 918-636-6476
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 690571
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City | TULSA
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State | OK
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Zip | 74169-0571
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Country | US
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Telephone | 918-636-6576
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SHARON ELAINE NELSON
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Credential | LPC
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Telephone | 918-639-6492
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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 |
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