Provider Demographics
NPI:1477216059
Name:TD BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:TD BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:DRAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-595-2555
Mailing Address - Street 1:2227 S GARNETT RD
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74129-5119
Mailing Address - Country:US
Mailing Address - Phone:479-595-2555
Mailing Address - Fax:479-595-2555
Practice Address - Street 1:2227 S GARNETT RD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74129-5119
Practice Address - Country:US
Practice Address - Phone:479-595-2555
Practice Address - Fax:479-595-2555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)