Provider Demographics
NPI:1205177656
Name:CURTIS, THEODORE EDWARD JR
Entity Type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:EDWARD
Last Name:CURTIS
Suffix:JR
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 1:26247 E 86TH ST S
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-6163
Mailing Address - Country:US
Mailing Address - Phone:918-576-3840
Mailing Address - Fax:
Practice Address - Street 1:26247 E 86TH ST S
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74014-6163
Practice Address - Country:US
Practice Address - Phone:918-576-3840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor