Organization
PHILLIP A BLACK LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHILLIP A BLACK MS (OWNER)
(918) 605-8614
Entity
Organization
Contact information
Practice address
4815 S HARVARD AVE STE 428, TULSA, OK 74135-3068
(918) 605-8614
Mailing address
500 S SWEET GUM AVE, BROKEN ARROW, OK 74012-4543
(918) 605-8614
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
2649
OK
Other
Enumeration date
03/01/2016
Last updated
03/01/2016
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