MEDICARE: KEITH MROZINSKI

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
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1871815019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITH MROZINSKI

Provider Business Mailing Address
First Line	:	4528 S SHERIDAN RD
Second Line	:	STE 101
City	:	TULSA
State	:	OK
Zip	:	74145-1140
Country	:	US
Telephone Number	:	918-398-7979
Fax Number	:	918-398-7938

Provider Business Practice Location Address
First Line	:	4528 S SHERIDAN RD
Second Line	:	STE 101
City	:	TULSA
State	:	OK
Zip	:	74145-1140
Country	:	US
Telephone Number	:	918-398-7979
Fax Number	:	918-398-7938

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2010
Last Update Date	:	02/15/2010

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Directions to “ KEITH MROZINSKI ” Practice Location

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