Organization
TULSA FAMILY DEVELOPMENT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELISA M WOODHEAD CMA (AAMA) (CREDENTIALING MANAGER)
(918) 299-8232
Entity
Organization
Contact information
Practice address
4520 S HARVARD AVE STE 200C, TULSA, OK 74135-2925
(918) 743-3224
(918) 743-9623
Mailing address
4520 S HARVARD AVE STE 200C, TULSA, OK 74135-2925
(918) 743-3224
(918) 743-9623
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
103TC0700X
Clinical Psychologist
—
—
103TC1900X
Counseling Psychologist
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1320
PSYCHOLOGIST LICENSE
OK
01
—
411
PSYCHOLOGIST LICENSE
OK
Enumeration date
06/15/2006
Last updated
10/07/2019
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