Provider Demographics
NPI:1881868594
Name:DOMESTIC VIOLENCE INTERVENTION SERVICES, INC.
Entity Type:Organization
Organization Name:DOMESTIC VIOLENCE INTERVENTION SERVICES, INC.
Other - Org Name:DVIS/CALL RAPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:REDMON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:918-585-3170
Mailing Address - Street 1:4300 S HARVARD AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2619
Mailing Address - Country:US
Mailing Address - Phone:918-585-3170
Mailing Address - Fax:
Practice Address - Street 1:4300 S HARVARD AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2619
Practice Address - Country:US
Practice Address - Phone:918-585-3170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK675OtherODMHSAS