1932344835 NPI number — COLLABORATIVE THERAPY SERVICES INC

Table of content: ALEXANDER CHISOLM COLEMAN M.D. (NPI 1306052527)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932344835 NPI number — COLLABORATIVE THERAPY SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLLABORATIVE THERAPY SERVICES 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:
Provider Other Organization Name Type Code:
6
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:
1932344835
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2221 W DETROIT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROKEN ARROW
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74012-3628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-615-6492
Provider Business Mailing Address Fax Number:
918-615-6493

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2221 W DETROIT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROKEN ARROW
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74012-3628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-615-6492
Provider Business Practice Location Address Fax Number:
918-615-6493
Provider Enumeration Date:
12/05/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WOODWARD
Authorized Official First Name:
LAUREN
Authorized Official Middle Name:
ELIZABETH
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
918-809-5483

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200224210A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200224210C , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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