Organization
TALKING LEAVES JOB CORPS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAY LITTLEJOHN (CENTER DIRECTOR)
(918) 207-3301
Entity
Organization
Contact information
Practice address
5700 BALD HILL ROAD, TAHLEQUAH, OK 74465-1066
(918) 456-9959
(918) 207-3499
Mailing address
PO BOX 1066, 5700 BALD HILL ROAD, TAHLEQUAH, OK 74465-1066
(918) 456-9959
(918) 207-3499
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
197
OK
122300000X
Dentist
4359
OK
207Q00000X
Family Medicine Physician
Primary
14708
OK
363LF0000X
Family Nurse Practitioner
74414
OK
Other
Enumeration date
04/21/2016
Last updated
04/21/2016
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