Basic Information
| Provider Information | |||||||||
| NPI: | 1689851982 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DOMESTIC VIOLENCE INTERVENTION SERVICES/ CALL RAPE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1607 N HARTFORD AVE | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741064304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185847500 | ||||||||
| FaxNumber: | 9185852676 | ||||||||
| Practice Location | |||||||||
| Address1: | 4300 S HARVARD AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741352619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185853163 | ||||||||
| FaxNumber: | 9185841835 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2008 | ||||||||
| LastUpdateDate: | 01/29/2008 | ||||||||
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| AuthorizedOfficialLastName: | BOOTH | ||||||||
| AuthorizedOfficialFirstName: | TRACEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9185853163 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MSW, LSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | 7243 | OK | Y | Agencies | Case Management |
No ID Information.