Organization
ADOLESCENTS AND FAMILIES AT RISK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK J INGRAM L.P.C. (CHEIF EXCECUTIVE OFFICER)
(918) 402-9858
Entity
Organization
Contact information
Practice address
9421 E 95TH PL, TULSA, OK 74133-6166
(918) 402-9858
Mailing address
9421 E 95TH PL, TULSA, OK 74133-6166
(918) 402-9858
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
1581
OK
Other
Enumeration date
07/07/2008
Last updated
07/07/2008
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