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General NPI Number Information
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NPI Number | 1851327464
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Entity Type | Organization
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Legal Business Name | PARKSIDE, INC.
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Dates
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Enumeration Date | 06/24/2006
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Last Update Date | 10/31/2012
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Provider Practice Location Address
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Address Line | 1620 E 12TH ST
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City | TULSA
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State | OK
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Zip | 74120-5407
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Country | US
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Telephone | 918-582-2131
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Fax |
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Provider Business Mailing Address
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Address Line | 1620 E 12TH ST
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City | TULSA
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State | OK
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Zip | 74120-5407
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Country | US
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Telephone | 918-582-2131
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MRS. SAUNYA D MOORE
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Credential |
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Telephone | 918-582-2131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 2261
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 2261
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | 2261
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License Number State | OK
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