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General NPI Number Information
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NPI Number | 1336811041
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Entity Type | Organization
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Legal Business Name | FAITH HEALTH CENTER, LLC
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Dates
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Enumeration Date | 09/30/2021
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Last Update Date | 09/30/2021
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Provider Practice Location Address
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Address Line | 10501 S QUEBEC AVE
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City | TULSA
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State | OK
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Zip | 74137-6234
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Country | US
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Telephone | 918-876-0606
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Fax | 918-876-0604
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Provider Business Mailing Address
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Address Line | PO BOX 311
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City | JENKS
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State | OK
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Zip | 74037-0311
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Country | US
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Telephone | 918-876-0606
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Fax | 918-876-0604
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Authorized Official
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Title or Position | OWNER
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Name | JUDY WAGGA
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Credential | PMHNP
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Telephone | 918-876-0606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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