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General NPI Number Information
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NPI Number | 1659692010
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Entity Type | Organization
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Legal Business Name | 12&12 INC
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Dates
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Enumeration Date | 06/18/2010
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Last Update Date | 06/18/2010
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Provider Practice Location Address
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Address Line | 6333 E SKELLY DR
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City | TULSA
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State | OK
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Zip | 74135-6106
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Country | US
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Telephone | 918-664-4224
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Fax | 918-663-0203
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Provider Business Mailing Address
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Address Line | 6333 E SKELLY DR
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City | TULSA
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State | OK
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Zip | 74135-6106
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Country | US
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Telephone | 918-664-4224
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Fax | 918-663-0203
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Authorized Official
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Title or Position | CASEMANAGER
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Name | MRS. WAYNETTA FAYE BRAWDY
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Credential | CM
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Telephone | 918-664-4224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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