Organization
FAMILY THERAPY AND RENEWAL CENTER PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TALITHA SUSAN BACHMANN LPC (MEMBER)
(918) 369-4950
Entity
Organization
Contact information
Practice address
6717 S YALE AVE STE 202, TULSA, OK 74136-3328
(918) 369-4950
(918) 369-4951
Mailing address
6717 S YALE AVE STE 202, TULSA, OK 74136-3328
(918) 369-4950
(918) 369-4951
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
3728
OK
101YP2500X
Professional Counselor
Primary
3752
OK
106H00000X
Marriage & Family Therapist
982
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200467210A
—
OK
Enumeration date
12/05/2012
Last updated
11/27/2017
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