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General NPI Number Information
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NPI Number | 1467766717
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Entity Type | Individual
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Provider Name | BREN JELEA ULBERG LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/28/2010
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Last Update Date | 11/02/2018
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Provider Practice Location Address
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Address Line | 4444 E 41ST ST
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City | TULSA
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State | OK
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Zip | 74135-2527
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Country | US
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Telephone | 918-619-4400
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Fax | 918-660-3631
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Provider Business Mailing Address
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Address Line | 6028 S 66TH EAST AVE STE. 105
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City | TULSA
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State | OK
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Zip | 74145-9231
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Country | US
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Telephone | 918-361-1619
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Fax | 918-499-2280
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 4593
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License Number State | OK
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