Provider Demographics
NPI:1295373777
Name:HEARTLAND RESOLUTION THERAPY, LLC
Entity Type:Organization
Organization Name:HEARTLAND RESOLUTION THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:M
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:918-557-9141
Mailing Address - Street 1:13928 S 300TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:COWETA
Mailing Address - State:OK
Mailing Address - Zip Code:74429-7825
Mailing Address - Country:US
Mailing Address - Phone:918-557-9141
Mailing Address - Fax:
Practice Address - Street 1:4821 S SHERIDAN RD STE 217
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-5716
Practice Address - Country:US
Practice Address - Phone:918-212-6567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty