| Phases Of Change Interventions, Inc | |
|
5001 S 67th East Ave Tulsa OK 74145-5708 | |
| (918) 852-0416 | |
| Not Available |
| Full Name | Phases Of Change Interventions, Inc |
|---|---|
| Speciality | Social Worker |
| Location | 5001 S 67th East Ave, Tulsa, Oklahoma |
| Authorized Official Name and Position | Brandi Michelle Inda (OWNDER) |
| Authorized Official Contact | 9188520416 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Phases Of Change Interventions, Inc Po Box 4318 Tulsa OK 74159-0318 Ph: (918) 852-0416 | Phases Of Change Interventions, Inc 5001 S 67th East Ave Tulsa OK 74145-5708 Ph: (918) 852-0416 |
| NPI Number | 1376310995 |
|---|---|
| Provider Enumeration Date | 12/04/2023 |
| Last Update Date | 12/04/2023 |
| Certification Date | 12/04/2023 |
| Medicare PECOS PAC ID | 1850738626 |
|---|---|
| Medicare Enrollment ID | O20240328002104 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376310995 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Brandi Inda |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1447787858 PECOS PAC ID: 2769829530 Enrollment ID: I20240403001551 |
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