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General NPI Number Information
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NPI Number | 1861877441
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Entity Type | Organization
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Legal Business Name | LEADER PROFESSIONAL SERVICES LLC
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Dates
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Enumeration Date | 07/24/2015
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Last Update Date | 12/07/2022
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Provider Practice Location Address
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Address Line | 4500 S GARNETT RD STE 908
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City | TULSA
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State | OK
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Zip | 74146-5214
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Country | US
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Telephone | 918-829-4374
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Fax | 918-602-1207
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Provider Business Mailing Address
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Address Line | 4500 S GARNETT RD STE 908
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City | TULSA
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State | OK
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Zip | 74146-5214
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Country | US
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Telephone | 918-808-8309
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Fax | 918-602-1207
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Authorized Official
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Title or Position | OWNER/COUNSELOR
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Name | CHRISTENE RAENEA SCOTT
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Credential | MS, LPC-S, RPT-S
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Telephone | 918-808-8309
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 5204
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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