Provider Demographics
NPI:1538698899
Name:ROYAL, PATEISHA (BA)
Entity Type:Individual
Prefix:
First Name:PATEISHA
Middle Name:
Last Name:ROYAL
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7813 E INDEPENDENCE ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74115-6917
Mailing Address - Country:US
Mailing Address - Phone:918-777-6467
Mailing Address - Fax:
Practice Address - Street 1:7813 E. INDEPENDENCE ST.
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74115
Practice Address - Country:US
Practice Address - Phone:918-777-6467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No101Y00000XBehavioral Health & Social Service ProvidersCounselor