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General NPI Number Information
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NPI Number | 1275877144
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Entity Type | Organization
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Legal Business Name | TRAUMA CENTER FOR CHILDREN AND FAMILIES, L.L.C.
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Dates
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Enumeration Date | 11/16/2012
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Last Update Date | 11/16/2012
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Provider Practice Location Address
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Address Line | 2021 S LEWIS AVE SUITE 620
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City | TULSA
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State | OK
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Zip | 74104-5733
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Country | US
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Telephone | 918-381-6477
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Fax |
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Provider Business Mailing Address
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Address Line | 3741 S XANTHUS AVE
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City | TULSA
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State | OK
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Zip | 74105-8141
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Country | US
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Telephone | 918-381-6477
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Fax |
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Authorized Official
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Title or Position | SOLE OWNER
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Name | MRS. MARISSA ANNA CARPENTER
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Credential | L. C. S. W.
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Telephone | 918-381-6477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 4052
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License Number State | OK
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