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General NPI Number Information
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NPI Number | 1720328545
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Entity Type | Organization
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Legal Business Name | BEHAVIORAL HEALTH AFFILIATES OF TULSA
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Dates
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Enumeration Date | 02/15/2013
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Last Update Date | 02/15/2013
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Provider Practice Location Address
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Address Line | 7146 S BRADEN AVE SUITE 500
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City | TULSA
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State | OK
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Zip | 74136-6371
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Country | US
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Telephone | 918-488-6165
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Fax |
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Provider Business Mailing Address
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Address Line | 7146 S BRADEN AVE SUITE 500
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City | TULSA
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State | OK
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Zip | 74136-6371
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Country | US
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Telephone | 918-488-6165
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JANET WILLIS
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Credential | PH.D.
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Telephone | 918-488-6165
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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 | 1600
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number | 566
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License Number State | OK
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