Provider Demographics
NPI:1225658321
Name:INDIVIDUAL AND FAMILY MATTERS LLC.
Entity Type:Organization
Organization Name:INDIVIDUAL AND FAMILY MATTERS LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARQUITA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-313-5835
Mailing Address - Street 1:20216 E 43RD PL S
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-1595
Mailing Address - Country:US
Mailing Address - Phone:918-313-5835
Mailing Address - Fax:
Practice Address - Street 1:20216 E 43RD PL S
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74014-1595
Practice Address - Country:US
Practice Address - Phone:918-313-5835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-20
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty