| State Of Oklahoma | |
|
2323 South Harvard Tulsa OK 74114 | |
| (918) 293-2140 | |
| (918) 912-7164 |
| Full Name | State Of Oklahoma |
|---|---|
| Speciality | Behavior Analyst |
| Location | 2323 South Harvard, Tulsa, Oklahoma |
| Authorized Official Name and Position | Wilfred Stephen Sampson (CLINICAL BEHAVIORAL HEALTHCARE SPEC) |
| Authorized Official Contact | 9182932140 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| State Of Oklahoma 2323 South Harvard Tulsa OK 74114 Ph: (918) 293-2140 | State Of Oklahoma 2323 South Harvard Tulsa OK 74114 Ph: (918) 293-2140 |
| NPI Number | 1790922185 |
|---|---|
| Provider Enumeration Date | 01/07/2009 |
| Last Update Date | 02/01/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790922185 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
| 320800000X | Community Based Residential Treatment Facility, Mental Illness | (* (Not Available)) | Secondary |
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