Provider Demographics
NPI:1841713609
Name:SIRES, DAVID JOSH
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JOSH
Last Name:SIRES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3202 S MEMORIAL DR STE 2
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-1323
Mailing Address - Country:US
Mailing Address - Phone:918-629-5047
Mailing Address - Fax:918-665-1830
Practice Address - Street 1:3202 S MEMORIAL DR STE 2
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-1323
Practice Address - Country:US
Practice Address - Phone:918-629-5047
Practice Address - Fax:918-665-1830
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-24
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health