| NPI | 1518715606 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESS JOSLIN Insurance Credentialing Specialist 918-766-8217 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry | |
| 133N00000X Nutritionist | |
| 323P00000X Psychiatric Residential Treatment Facility | |
| 133NN1002X Nutritionist, Nutrition, Education | |
| 133V00000X Dietitian, Registered | |
| 207Q00000X Family Medicine | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 208D00000X General Practice | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| Enumeration Date | 2024-05-13 |
| Last Update Date | 2025-09-22 |