Organization
SALLISAW MENTAL HEALTH LLC
Active
Organization
SALLISAW MENTAL HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAUNNA FUNSTON (MANAGER)
(918) 289-0102
Entity
Organization
Contact information
Practice address
204 E CHOCTAW AVE, SALLISAW, OK 74955-4604
(918) 289-0201
Mailing address
7302 S YALE AVE, TULSA, OK 74136-7027
(918) 289-0102
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Enumeration date
08/16/2019
Last updated
08/16/2019
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