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General NPI Number Information
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NPI Number | 1538383161
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Entity Type | Organization
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Legal Business Name | CHRISTIAN COUNSELING CENTER OF TULSA
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 08/31/2011
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Provider Practice Location Address
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Address Line | 4930 S SHERIDAN RD
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City | TULSA
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State | OK
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Zip | 74145-5712
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Country | US
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Telephone | 918-392-4008
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Fax | 918-392-4009
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Provider Business Mailing Address
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Address Line | 4930 S SHERIDAN RD
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City | TULSA
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State | OK
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Zip | 74145-5712
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Country | US
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Telephone | 918-392-4008
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Fax | 918-392-4009
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Authorized Official
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Title or Position | OFFICE ADMINISTRATOR
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Name | MRS. LINDSEY NICHOLE NIEMAN
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Credential |
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Telephone | 918-392-4008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1015
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License Number State | OK
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