Provider Demographics
NPI:1497592596
Name:SOAAK CLINICS LLC
Entity type:Organization
Organization Name:SOAAK CLINICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:WIDNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-770-2271
Mailing Address - Street 1:2448 E 81ST ST STE 5100
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-4289
Mailing Address - Country:US
Mailing Address - Phone:918-747-7400
Mailing Address - Fax:
Practice Address - Street 1:2448 E 81ST ST STE 5100
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-4289
Practice Address - Country:US
Practice Address - Phone:918-747-7400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-15
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty