Provider Demographics
NPI:1831676097
Name:CLIENT DIRECT BEHAVIORAL HEALTH SERVICES PLLC
Entity type:Organization
Organization Name:CLIENT DIRECT BEHAVIORAL HEALTH SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLN DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:918-282-3049
Mailing Address - Street 1:6130 E 32ND ST STE 107
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-5454
Mailing Address - Country:US
Mailing Address - Phone:918-282-3049
Mailing Address - Fax:
Practice Address - Street 1:6130 E 32ND ST STE 116
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-5454
Practice Address - Country:US
Practice Address - Phone:918-282-3049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-20
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5975101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1568712461Medicaid