Individual
JUSTIN CHURCHILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1860 E 15TH ST, TULSA, OK 74104-4611
(918) 949-4430
Mailing address
107 S 196TH EAST AVE, TULSA, OK 74108-7717
(918) 808-7066
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
05/29/2020
Last updated
05/29/2020
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