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NPI Code Detail

MEDICARE: SOAAK CLINICS LLC

MEDICARE: SOAAK CLINICS LLC
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
1103TC1900XCounseling Psychologist
2101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1497592596
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOAAK CLINICS LLC
Provider Business Mailing Address
First Line : 2448 E 81ST ST STE 5100
Second Line :
City : TULSA
State : OK
Zip : 74137-4289
Country : US
Telephone Number : 918-747-7400
Fax Number :
Provider Business Practice Location Address
First Line : 2448 E 81ST ST STE 5100
Second Line :
City : TULSA
State : OK
Zip : 74137-4289
Country : US
Telephone Number : 918-747-7400
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : LAURA WIDNEY
Credential :
Telephone Number : 918-770-2271
Provider Enumeration Date : 07/15/2024
Last Update Date : 07/17/2024

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Directions to “SOAAK CLINICS LLC ” Practice Location

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