Provider Demographics
NPI: | 1174636385 |
---|---|
Name: | COMPREHENSIVE COMMUNITY REHAB SERVICES |
Entity Type: | Organization |
Organization Name: | COMPREHENSIVE COMMUNITY REHAB SERVICES |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CHIEF OPERATING OFFICER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | TERRY |
Authorized Official - Middle Name: | G |
Authorized Official - Last Name: | SHAW |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PHD |
Authorized Official - Phone: | 918-488-6165 |
Mailing Address - Street 1: | 7146 S BRADEN AVE STE 500 |
Mailing Address - Street 2: | |
Mailing Address - City: | TULSA |
Mailing Address - State: | OK |
Mailing Address - Zip Code: | 74136-6376 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 918-488-6165 |
Mailing Address - Fax: | 918-488-8021 |
Practice Address - Street 1: | 7146 S BRADEN AVE STE 500 |
Practice Address - Street 2: | |
Practice Address - City: | TULSA |
Practice Address - State: | OK |
Practice Address - Zip Code: | 74136-6376 |
Practice Address - Country: | US |
Practice Address - Phone: | 918-488-6165 |
Practice Address - Fax: | 918-488-8021 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-08-15 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
103G00000X, 103T00000X, 103TB0200X, 103TR0400X, 224Z00000X, 225100000X, 225200000X, 225C00000X, 225X00000X, 235Z00000X | ||
OK | RC7247-7247 | 320700000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Not Answered | 103G00000X | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | Group - Multi-Specialty | |
Not Answered | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
Not Answered | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | Group - Multi-Specialty |
Not Answered | 103TR0400X | Behavioral Health & Social Service Providers | Psychologist | Rehabilitation | Group - Multi-Specialty |
Not Answered | 224Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Group - Multi-Specialty | |
Not Answered | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
Not Answered | 225200000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | Group - Multi-Specialty | |
Not Answered | 225C00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Counselor | Group - Multi-Specialty | |
Not Answered | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
Not Answered | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty | |
Not Answered | 320700000X | Residential Treatment Facilities | Residential Treatment Facility, Physical Disabilities |