Provider Demographics
NPI:1790246619
Name:TULSA FAMILY PSYCHIATRY & WELLNESS, INC
Entity Type:Organization
Organization Name:TULSA FAMILY PSYCHIATRY & WELLNESS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:M
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:918-268-9578
Mailing Address - Street 1:2526 E 71ST ST STE J
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-5576
Mailing Address - Country:US
Mailing Address - Phone:918-268-9578
Mailing Address - Fax:918-471-2854
Practice Address - Street 1:2526 E 71ST ST STE J
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-5576
Practice Address - Country:US
Practice Address - Phone:918-268-9578
Practice Address - Fax:918-471-2854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-26
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1285640102OtherNPI
OK200001630AMedicaid