| The Tristesse Grief Center | |
|
2502 E 71st St Tulsa OK 74136-5531 | |
| (918) 587-1200 | |
| (918) 712-7399 |
| Full Name | The Tristesse Grief Center |
|---|---|
| Speciality | Counselor |
| Location | 2502 E 71st St, Tulsa, Oklahoma |
| Authorized Official Name and Position | Lauri Lenora (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 9185871200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Tristesse Grief Center 2502 E 71st St Tulsa OK 74136-5531 Ph: (918) 587-1200 | The Tristesse Grief Center 2502 E 71st St Tulsa OK 74136-5531 Ph: (918) 587-1200 |
| NPI Number | 1346754314 |
|---|---|
| Provider Enumeration Date | 11/28/2017 |
| Last Update Date | 03/02/2018 |
| Medicare PECOS PAC ID | 3577824754 |
|---|---|
| Medicare Enrollment ID | O20180305000227 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346754314 | NPI | - | NPPES |
| Provider Name | Susan L Miller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841704301 PECOS PAC ID: 5890058887 Enrollment ID: I20180403002920 |
| Provider Name | Richard Young Modenbach |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053643429 PECOS PAC ID: 7214355668 Enrollment ID: I20200916002008 |
| Provider Name | Timothy A Dearhamer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316492382 PECOS PAC ID: 3678980430 Enrollment ID: I20210324001017 |
| Provider Name | Melinda D Humphrey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215671466 PECOS PAC ID: 4385031798 Enrollment ID: I20220503000862 |
| Provider Name | Lucretia R Pardinas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760163703 PECOS PAC ID: 9931561537 Enrollment ID: I20230814003491 |
| Provider Name | Maureen E Grizzle |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1821173824 PECOS PAC ID: 5395195366 Enrollment ID: I20240103002351 |
| Provider Name | Emilie Jean Smith |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1831231422 PECOS PAC ID: 2769833086 Enrollment ID: I20240110003884 |
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