Basic Information
| Provider Information | |||||||||
| NPI: | 1770751760 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DAYBREAK FAMILY SERVICES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1516 S. BOSTON AVE. | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741194029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185616000 | ||||||||
| FaxNumber: | 9185616001 | ||||||||
| Practice Location | |||||||||
| Address1: | 1516 S. BOSTON AVE. | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741194029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185616000 | ||||||||
| FaxNumber: | 9185616001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2008 | ||||||||
| LastUpdateDate: | 11/06/2015 | ||||||||
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| AuthorizedOfficialLastName: | PETERS | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | LCSW | ||||||||
| AuthorizedOfficialTelephone: | 9185616000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.