Provider Demographics
NPI:1164445490
Name:PSYCHIATRY OF TULSA, P.C.
Entity Type:Organization
Organization Name:PSYCHIATRY OF TULSA, P.C.
Other - Org Name:SERENITY PSYCHIATRIC SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAZEM
Authorized Official - Middle Name:H
Authorized Official - Last Name:SOKKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-627-8858
Mailing Address - Street 1:4833 S SHERIDAN RD
Mailing Address - Street 2:SUITE 408
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-5750
Mailing Address - Country:US
Mailing Address - Phone:918-627-8858
Mailing Address - Fax:918-627-4004
Practice Address - Street 1:6108 S MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-1933
Practice Address - Country:US
Practice Address - Phone:918-627-8858
Practice Address - Fax:918-627-4004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20856103TF0000X
2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100219880Medicaid
OKH55348Medicare UPIN
OK800522275Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER