Provider Demographics
NPI:1821127325
Name:MENTAL HEALTH ASSOCIATION IN TULSA, INC.
Entity Type:Organization
Organization Name:MENTAL HEALTH ASSOCIATION IN TULSA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HORETH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-382-2414
Mailing Address - Street 1:1870 S BOULDER AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74119-5234
Mailing Address - Country:US
Mailing Address - Phone:918-585-1213
Mailing Address - Fax:918-585-1263
Practice Address - Street 1:1870 S BOULDER AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74119-5234
Practice Address - Country:US
Practice Address - Phone:918-585-1213
Practice Address - Fax:918-585-1263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK778-03OtherBP-OUTREACH
OK778-01OtherSAFE HAVEN
OK778-04Other12TH STREET SAFE HAVEN