Basic Information
| Provider Information | |||||||||
| NPI: | 1821127325 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MENTAL HEALTH ASSOCIATION IN TULSA, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1870 S BOULDER AVE | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741195234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185851213 | ||||||||
| FaxNumber: | 9185851263 | ||||||||
| Practice Location | |||||||||
| Address1: | 1870 S BOULDER AVE | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741195234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185851213 | ||||||||
| FaxNumber: | 9185851263 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2007 | ||||||||
| LastUpdateDate: | 03/18/2008 | ||||||||
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| AuthorizedOfficialLastName: | HORETH | ||||||||
| AuthorizedOfficialFirstName: | SUE | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CONTROLLER | ||||||||
| AuthorizedOfficialTelephone: | 9183822414 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251V00000X | Y | Agencies | Voluntary or Charitable |
ID Information
| ID | Type | State | Issuer | Description | 778-03 | 01 | OK | BP-OUTREACH | OTHER | 778-01 | 01 | OK | SAFE HAVEN | OTHER | 778-04 | 01 | OK | 12TH STREET SAFE HAVEN | OTHER |