Organization
SOUTH PEORIA NEIGHBORHOOD CONNECTION FOUNDATION
Active
Other names
South Tulsa Community House
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LANNY R ENDICOTT LCSW, LMFT (PRESIDENT)
(918) 830-1523
Entity
Organization
Contact information
Practice address
1208 E 58TH ST, TULSA, OK 74105-8401
(918) 742-5597
(918) 742-4485
Mailing address
1208 E 58TH ST, TULSA, OK 74105-8401
(918) 742-5597
(918) 742-4485
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
296
OK
251S00000X
Community/Behavioral Health Agency
328
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100723970B
—
OK
05
—
1508994138
—
OK
Enumeration date
12/25/2011
Last updated
12/25/2011
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