Organization
PARKSIDE, INC.
Active
Other names
Parkside Professional
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SAUNYA D. MOORE (CFO)
(918) 588-8874
Entity
Organization
Contact information
Practice address
1620 E 12TH ST, TULSA, OK 74120-5407
(918) 588-8874
Mailing address
1620 E 12TH ST, TULSA, OK 74120-5407
(918) 588-8874
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
2261
OK
261QM0855X
Adolescent and Children Mental Health Clinic/Center
2261
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100738360D
—
OK
Enumeration date
05/24/2007
Last updated
10/31/2012
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