Provider Demographics
NPI:1871069245
Name:SOUTHERN NAZARENE UNIVERSITY
Entity type:Organization
Organization Name:SOUTHERN NAZARENE UNIVERSITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:N
Authorized Official - Last Name:SAPP
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:405-717-6200
Mailing Address - Street 1:6612 NW 42ND ST
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-2764
Mailing Address - Country:US
Mailing Address - Phone:405-717-6200
Mailing Address - Fax:
Practice Address - Street 1:6612 NW 42ND ST
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-2764
Practice Address - Country:US
Practice Address - Phone:405-717-6200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHERN NAZARENE UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-23
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty