| Oklahoma Mentor | |
|
7615 E 63rd Pl Three Memorial Place, Suite 130 Tulsa OK 74133-1244 | |
| (918) 254-6748 | |
| Not Available |
| Full Name | Oklahoma Mentor |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 7615 E 63rd Pl, Tulsa, Oklahoma |
| Authorized Official Name and Position | Brett Ian Cohen (COO) |
| Authorized Official Contact | 8003885150 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Oklahoma Mentor 313 Congress St Boston MA 02210-1218 Ph: () - | Oklahoma Mentor 7615 E 63rd Pl Three Memorial Place, Suite 130 Tulsa OK 74133-1244 Ph: (918) 254-6748 |
| NPI Number | 1316152622 |
|---|---|
| Provider Enumeration Date | 05/11/2007 |
| Last Update Date | 03/05/2023 |
| Certification Date | 03/05/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316152622 | NPI | - | NPPES |
| 100630280 K | Medicaid | OK | |
| 100630280 C | Medicaid | OK | |
| 100630280 B | Medicaid | OK | |
| 100630280 D | Medicaid | OK | |
| 100630280 F | Medicaid | OK | |
| 100630280 H | Medicaid | OK | |
| 100630280 A | Medicaid | OK | |
| 100630280 E | Medicaid | OK | |
| 100630280 G | Medicaid | OK | |
| 100630280 I | Medicaid | OK | |
| 100630280 J | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 376J506 (Oklahoma) | Primary |
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