Provider Demographics
NPI:1003271867
Name:THE CENTER FOR GRIEF RECOVERY & FAMILY SERVICES LLC
Entity Type:Organization
Organization Name:THE CENTER FOR GRIEF RECOVERY & FAMILY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-698-4424
Mailing Address - Street 1:8280 E DESTINY LN
Mailing Address - Street 2:
Mailing Address - City:SKIATOOK
Mailing Address - State:OK
Mailing Address - Zip Code:74070-5266
Mailing Address - Country:US
Mailing Address - Phone:918-698-4424
Mailing Address - Fax:
Practice Address - Street 1:4867 S SHERIDAN RD
Practice Address - Street 2:SUITE 703-A
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-5747
Practice Address - Country:US
Practice Address - Phone:918-698-4424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management