State of Oklahoma

NPI #1578580916 in Tulsa, Oklahoma

Provider Information

NPI Number: 1578580916
Entity Type: Organization
Organization Name: State of Oklahoma
Primary Specialty: Psychiatric Hospital
Enumeration Date: Jul 15, 2006
Last Updated: Sep 6, 2023

Practice Location

Address: 2323 S HARVARD AVE
City: Tulsa
State: Oklahoma
ZIP Code: 74114-3301
Phone: (918) 293-2140

Authorized Official

Name: AUTUMN NICKELSON
Title: INTERIM EXECUTIVE DIRECTOR
Phone: (580) 256-8615

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Mental Health (Including Community Mental Health Center) — Mental Health (Including Community Mental Health Center)	261QM0801X
Clinic/Center - Medical Specialty — Medical Specialty	261QM2500X
Psychiatric Hospital	283Q00000X	Primary

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