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General NPI Number Information
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NPI Number | 1457737025
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Entity Type | Organization
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Legal Business Name | LUSSIER PSYCHIATRIC CLINIC
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Dates
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Enumeration Date | 08/06/2015
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Last Update Date | 12/02/2015
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Provider Practice Location Address
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Address Line | 5525 E 51ST ST SUITE 310
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City | TULSA
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State | OK
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Zip | 74135-7461
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Country | US
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Telephone | 918-200-1742
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Fax | 866-580-7221
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Provider Business Mailing Address
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Address Line | 5525 E 51ST ST SUITE 310
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City | TULSA
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State | OK
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Zip | 74135-7461
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Country | US
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Telephone | 918-200-1742
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Fax | 866-580-7221
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Authorized Official
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Title or Position | BILLING SPECIALIST
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Name | CARISSA STEPHANS
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Credential |
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Telephone | 918-200-1742
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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 | 25858
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License Number State | OK
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