Organization
GRACE THERAPY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MYLINDA RENEE FANJ MS, LPC (MENTAL HEALTH PROFESSIONAL)
(918) 869-5544
Entity
Organization
Contact information
Practice address
4870 S LEWIS AVE, SUITE 190, TULSA, OK 74105-5151
(918) 869-5544
Mailing address
4870 S LEWIS AVE, SUITE 190, TULSA, OK 74105-5151
(918) 869-5544
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
4921
OK
Other
Enumeration date
02/01/2016
Last updated
02/01/2016
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