Provider Demographics
NPI:1912291543
Name:MENTAL HEALTH ASSOCIATION IN TULSA
Entity Type:Organization
Organization Name:MENTAL HEALTH ASSOCIATION IN TULSA
Other - Org Name:MAP
Other - Org Type:Other Name
Authorized Official - Title/Position:TEAM LEADER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:HENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-955-6245
Mailing Address - Street 1:3322 E 30TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-6108
Mailing Address - Country:US
Mailing Address - Phone:918-382-2412
Mailing Address - Fax:918-585-1263
Practice Address - Street 1:3322 E 30TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-6108
Practice Address - Country:US
Practice Address - Phone:918-382-2412
Practice Address - Fax:918-585-1263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management