Provider Demographics
NPI:1093254641
Name:SKINNER, ADAM
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:SKINNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4636 S HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2908
Mailing Address - Country:US
Mailing Address - Phone:918-382-7300
Mailing Address - Fax:918-392-3471
Practice Address - Street 1:600 W INDEPENDENCE ST
Practice Address - Street 2:STE. 900
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-4320
Practice Address - Country:US
Practice Address - Phone:405-275-1844
Practice Address - Fax:405-275-1124
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YA0400X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)