Provider Demographics
NPI:1336460443
Name:TULSA ALLIANCE ON MENTAL ILLNESS
Entity Type:Organization
Organization Name:TULSA ALLIANCE ON MENTAL ILLNESS
Other - Org Name:NAMI TULSA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:GUNNELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-902-1712
Mailing Address - Street 1:700 S BOSTON AVE
Mailing Address - Street 2:SUITE 219
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74119-1607
Mailing Address - Country:US
Mailing Address - Phone:918-587-6264
Mailing Address - Fax:
Practice Address - Street 1:700 S BOSTON AVE
Practice Address - Street 2:SUITE 219
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74119-1607
Practice Address - Country:US
Practice Address - Phone:918-587-6264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management