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NPI Code Detail

MEDICARE: TINA M BEVANS LCSW

MEDICARE:   TINA M BEVANS  LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker3592OK

General Provider Information

NPI Number : 1144422338
Entity Type Code : Individual
Provider Name (Legal Business Name) : TINA M BEVANS LCSW
Provider Business Mailing Address
First Line : PO BOX 140353
Second Line :
City : BROKEN ARROW
State : OK
Zip : 74014-0017
Country : US
Telephone Number : 918-313-2142
Fax Number :
Provider Business Practice Location Address
First Line : 3010 S HARVARD AVE
Second Line : STE 110
City : TULSA
State : OK
Zip : 74114-6126
Country : US
Telephone Number : 918-313-2142
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2007
Last Update Date : 09/21/2016

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Directions to “ TINA M BEVANS LCSW” Practice Location

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