Provider Demographics
NPI:1700211075
Name:BOAZ, THELMA BEATRICA
Entity Type:Individual
Prefix:
First Name:THELMA
Middle Name:BEATRICA
Last Name:BOAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 E 66TH PL APT 527
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3717
Mailing Address - Country:US
Mailing Address - Phone:918-855-0761
Mailing Address - Fax:
Practice Address - Street 1:1206 N BOSTON AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74106-4604
Practice Address - Country:US
Practice Address - Phone:918-855-0761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation