| Brain Body Soul Therapy And Wellness Llc | |
|
2488 E 81st St Ste 4821 Tulsa OK 74137-4290 | |
| (918) 236-0833 | |
| Not Available |
| Full Name | Brain Body Soul Therapy And Wellness Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 2488 E 81st St Ste 4821, Tulsa, Oklahoma |
| Authorized Official Name and Position | Robert Carson Raymond (PRESIDENT) |
| Authorized Official Contact | 9182360833 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Brain Body Soul Therapy And Wellness Llc 2834 E 90th St Unit 1806 Tulsa OK 74137-3377 Ph: (734) 646-4354 | Brain Body Soul Therapy And Wellness Llc 2488 E 81st St Ste 4821 Tulsa OK 74137-4290 Ph: (918) 236-0833 |
| NPI Number | 1366271512 |
|---|---|
| Provider Enumeration Date | 07/27/2024 |
| Last Update Date | 08/13/2024 |
| Certification Date | 08/13/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366271512 | NPI | - | NPPES |
| 200946240B | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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