Provider Demographics
NPI:1275877144
Name:TRAUMA CENTER FOR CHILDREN AND FAMILIES, L.L.C.
Entity Type:Organization
Organization Name:TRAUMA CENTER FOR CHILDREN AND FAMILIES, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:ANNA
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:L C S W
Authorized Official - Phone:918-381-6477
Mailing Address - Street 1:3741 S XANTHUS AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-8141
Mailing Address - Country:US
Mailing Address - Phone:918-381-6477
Mailing Address - Fax:
Practice Address - Street 1:2021 S LEWIS AVE
Practice Address - Street 2:SUITE 620
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5733
Practice Address - Country:US
Practice Address - Phone:918-381-6477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK40521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty