1225276637 NPI number — BEHAVIORAL TRANSFORMATIONS, INC

Table of content: (NPI 1225276637)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225276637 NPI number — BEHAVIORAL TRANSFORMATIONS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEHAVIORAL TRANSFORMATIONS, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SHERRY REAVES, LCSW
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225276637
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5840 S MEMORIAL DR
Provider Second Line Business Mailing Address:
SUITE 3003
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74145-9052
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-576-8744
Provider Business Mailing Address Fax Number:
918-728-6399

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5840 S MEMORIAL DR
Provider Second Line Business Practice Location Address:
SUITE 3003
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74145-9052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-576-8744
Provider Business Practice Location Address Fax Number:
918-728-6399
Provider Enumeration Date:
01/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
REAVES
Authorized Official First Name:
SHERRY
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
PRIVATE PRACTITIONER
Authorized Official Telephone Number:
918-576-8744

Provider Taxonomy Codes

  • Taxonomy code: 305S00000X , with the licence number:  3231 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1508908070 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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