Provider Demographics
NPI:1871815019
Name:MROZINSKI, KEITH
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:MROZINSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4528 S SHERIDAN RD
Mailing Address - Street 2:STE 101
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-1140
Mailing Address - Country:US
Mailing Address - Phone:918-398-7979
Mailing Address - Fax:918-398-7938
Practice Address - Street 1:4528 S SHERIDAN RD
Practice Address - Street 2:STE 101
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-1140
Practice Address - Country:US
Practice Address - Phone:918-398-7979
Practice Address - Fax:918-398-7938
Is Sole Proprietor?:No
Enumeration Date:2010-02-15
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor