Provider Demographics
NPI:1528453479
Name:MENTAL HEALTH ASSOCIATION OF TULSA
Entity type:Organization
Organization Name:MENTAL HEALTH ASSOCIATION OF TULSA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATHWASY CASE MANAGER SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NOE
Authorized Official - Middle Name:C
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:918-807-1742
Mailing Address - Street 1:1010 W 120TH ST S
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-2863
Mailing Address - Country:US
Mailing Address - Phone:918-807-1742
Mailing Address - Fax:
Practice Address - Street 1:1870 S BOULDER AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74119-5234
Practice Address - Country:US
Practice Address - Phone:918-807-1742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management