Provider Demographics
NPI:1619319738
Name:T.W. BOSLEY LLC
Entity Type:Organization
Organization Name:T.W. BOSLEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:TREBOR
Authorized Official - Middle Name:WELLINGTON
Authorized Official - Last Name:BOSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MHR, LPC
Authorized Official - Phone:405-535-1048
Mailing Address - Street 1:4421 APPLE BLOSSOM CIR
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-1007
Mailing Address - Country:US
Mailing Address - Phone:405-535-1048
Mailing Address - Fax:
Practice Address - Street 1:115 S PETERS AVE
Practice Address - Street 2:SUITE 11
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6065
Practice Address - Country:US
Practice Address - Phone:405-535-1048
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4759101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1003138710OtherPERSONAL PROVIDER NPI NUMBER