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
StateLicense IDTaxonomies
103G00000X, 103T00000X, 103TB0200X, 103TR0400X, 224Z00000X, 225100000X, 225200000X, 225C00000X, 225X00000X, 235Z00000X
OKRC7247-7247320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
Not Answered103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Multi-Specialty
Not Answered224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
Not Answered225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Not Answered320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities