Provider Demographics
NPI:1083939243
Name:LISA HART, INC.
Entity Type:Organization
Organization Name:LISA HART, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:918-492-2385
Mailing Address - Street 1:5110 S YALE AVE STE 412
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-7483
Mailing Address - Country:US
Mailing Address - Phone:918-492-2385
Mailing Address - Fax:
Practice Address - Street 1:5110 S YALE AVE STE 412
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-7483
Practice Address - Country:US
Practice Address - Phone:918-492-2385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-31
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty