Provider Demographics
NPI:1225566375
Name:ANGELA BAUER
Entity Type:Organization
Organization Name:ANGELA BAUER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:SHAYNA
Authorized Official - Middle Name:
Authorized Official - Last Name:EMSHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-831-9084
Mailing Address - Street 1:5427 E 110TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-7252
Mailing Address - Country:US
Mailing Address - Phone:918-691-3032
Mailing Address - Fax:
Practice Address - Street 1:5512 S LEWIS AVE STE 8B
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-7140
Practice Address - Country:US
Practice Address - Phone:539-777-1158
Practice Address - Fax:918-749-2774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK52121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty