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General NPI Number Information
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NPI Number | 1386372183
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Entity Type | Organization
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Legal Business Name | FOUR DIRECTIONS PSYCHOLOGICAL SERVICES PLLC
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Dates
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Enumeration Date | 08/10/2022
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Last Update Date | 09/01/2022
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Provider Practice Location Address
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Address Line | 5272 S LEWIS AVE # 277
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City | TULSA
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State | OK
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Zip | 74105-6544
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Country | US
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Telephone | 918-205-4797
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Fax | 866-598-3110
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Provider Business Mailing Address
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Address Line | 5272 S LEWIS AVE # 277
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City | TULSA
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State | OK
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Zip | 74105-6544
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Country | US
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Telephone | 918-205-4797
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Fax | 866-598-3110
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Authorized Official
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Title or Position | OWNER
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Name | ASHLEY LEFLORE
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Credential | PH.D
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Telephone | 918-205-4797
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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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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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