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General NPI Number Information
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NPI Number | 1760106793
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Entity Type | Organization
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Legal Business Name | LEMON TREE GROVE THERAPY CLINIC OF SOUTH TULSA LLC
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Dates
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Enumeration Date | 10/03/2022
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Last Update Date | 10/03/2022
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Provider Practice Location Address
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Address Line | 8252 S HARVARD AVE STE 151
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City | TULSA
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State | OK
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Zip | 74137-1646
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Country | US
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Telephone | 918-924-5058
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Fax |
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Provider Business Mailing Address
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Address Line | 8252 S HARVARD AVE STE 151
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City | TULSA
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State | OK
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Zip | 74137-1646
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Country | US
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Telephone | 918-924-5058
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ANTHONY TYLER OWENS
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Credential |
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Telephone | 539-240-4735
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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