Provider Demographics
NPI:1437444684
Name:MENTAL HEALTH ASSOC. IN TULSA
Entity Type:Organization
Organization Name:MENTAL HEALTH ASSOC. IN TULSA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SERVICE COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:GOWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-724-3558
Mailing Address - Street 1:3322 E 30TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-6108
Mailing Address - Country:US
Mailing Address - Phone:918-724-3558
Mailing Address - Fax:918-743-8845
Practice Address - Street 1:3322 E 30TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-6108
Practice Address - Country:US
Practice Address - Phone:918-724-3558
Practice Address - Fax:918-743-8845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management