Provider Demographics
NPI:1811228471
Name:MUSGRAVE, ERIN (ERIN MUSGRAVE)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:MUSGRAVE
Suffix:
Gender:F
Credentials:ERIN MUSGRAVE
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 SUITE 100
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74119
Mailing Address - Country:US
Mailing Address - Phone:918-907-1187
Mailing Address - Fax:
Practice Address - Street 1:1516 S BOSTON AVE STE 100
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74119-4003
Practice Address - Country:US
Practice Address - Phone:918-561-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional