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General NPI Number Information
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NPI Number | 1497474423
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Entity Type | Organization
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Legal Business Name | RISE THERAPEUTIC SERVICES, LLC
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Dates
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Enumeration Date | 08/23/2022
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 5400 CHARLES PAGE BLVD
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City | TULSA
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State | OK
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Zip | 74127-7548
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Country | US
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Telephone | 918-901-7512
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Fax | 918-900-0304
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Provider Business Mailing Address
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Address Line | 5400 CHARLES PAGE BLVD
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City | TULSA
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State | OK
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Zip | 74127-7548
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Country | US
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Telephone | 918-901-7512
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Fax | 918-900-0304
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Authorized Official
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Title or Position | OWNER
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Name | GARY ROBERTS JR.
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Credential | LPC
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Telephone | 918-901-7512
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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