Provider Demographics
NPI:1750668026
Name:MURILLO, CARISSA DEANNE
Entity Type:Individual
Prefix:MS
First Name:CARISSA
Middle Name:DEANNE
Last Name:MURILLO
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 1:1516 S BOSTON AVE
Mailing Address - Street 2:# 1
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74119-4003
Mailing Address - Country:US
Mailing Address - Phone:918-561-6001
Mailing Address - Fax:918-561-6001
Practice Address - Street 1:1516 S BOSTON AVE
Practice Address - Street 2:# 1
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74119-4003
Practice Address - Country:US
Practice Address - Phone:918-561-6001
Practice Address - Fax:918-561-6001
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health