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General NPI Number Information
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NPI Number | 1891167060
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Entity Type | Organization
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Legal Business Name | HEALTHY BOUNDARIES INC
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Dates
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Enumeration Date | 10/27/2015
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Last Update Date | 10/27/2015
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Provider Practice Location Address
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Address Line | 6028 S 66TH EAST AVE SUITE 105
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City | TULSA
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State | OK
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Zip | 74145-9231
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Country | US
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Telephone | 918-809-8164
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Fax | 918-499-2280
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Provider Business Mailing Address
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Address Line | 6028 S 66TH EAST AVE SUITE 105
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City | TULSA
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State | OK
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Zip | 74145-9231
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Country | US
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Telephone | 918-809-8164
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Fax | 918-499-2280
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DANIEL MERLE ULBERG II
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Credential | LPC
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Telephone | 918-809-8164
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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 | 4429
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License Number State | OK
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