Basic Information
| Provider Information | |||||||||
| NPI: | 1851800825 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SEYVA LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8522 S 70TH EAST AVE | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741335085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8324749703 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8522 S 70TH E AVE | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8324749703 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | PEREIRA | ||||||||
| AuthorizedOfficialFirstName: | JAMI | ||||||||
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| AuthorizedOfficialTitleorPosition: | LCSW | ||||||||
| AuthorizedOfficialTelephone: | 8324749703 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0855X | 4999 | OK | Y | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health |
No ID Information.