Provider Demographics
NPI:1770937229
Name:TALKING LEAVES JOB CORPS
Entity type:Organization
Organization Name:TALKING LEAVES JOB CORPS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CENTER DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTLEJOHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-207-3301
Mailing Address - Street 1:PO BOX 1066
Mailing Address - Street 2:5700 BALD HILL ROAD
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74465-1066
Mailing Address - Country:US
Mailing Address - Phone:918-456-9959
Mailing Address - Fax:918-207-3499
Practice Address - Street 1:5700 BALD HILL ROAD
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74465-1066
Practice Address - Country:US
Practice Address - Phone:918-456-9959
Practice Address - Fax:918-207-3499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK197103T00000X
OK4359122300000X
OK74414363LF0000X
OK14708207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty