Provider Demographics
NPI:1942840962
Name:DAVIES-ULIRSCH, ELIZABETH (MA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:DAVIES-ULIRSCH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:DAVIES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:1554 S YORKTOWN PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4918
Mailing Address - Country:US
Mailing Address - Phone:540-685-3284
Mailing Address - Fax:
Practice Address - Street 1:9717 E 42ND ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-3618
Practice Address - Country:US
Practice Address - Phone:918-270-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7394101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health