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NPI Code Detail

MEDICARE: QUENTIN HENLEY LCSW

MEDICARE: QUENTIN HENLEY 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 Worker1047OK

General Provider Information

NPI Number : 1912544131
Entity Type Code : Individual
Provider Name (Legal Business Name) : QUENTIN HENLEY LCSW
Provider Business Mailing Address
First Line : 6216 S LEWIS AVE STE 180
Second Line :
City : TULSA
State : OK
Zip : 74136-1077
Country : US
Telephone Number : 918-960-7407
Fax Number : 539-664-5738
Provider Business Practice Location Address
First Line : 2450 N HARVARD AVE
Second Line :
City : TULSA
State : OK
Zip : 74115-3140
Country : US
Telephone Number : 918-508-7135
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/06/2019
Last Update Date : 12/06/2019

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