Provider Demographics
NPI:1073787404
Name:RILEY, PATRICE D (MHR/MRC)
Entity type:Individual
Prefix:MS
First Name:PATRICE
Middle Name:D
Last Name:RILEY
Suffix:
Gender:F
Credentials:MHR/MRC
Other - Prefix:MRS
Other - First Name:PAT
Other - Middle Name:D
Other - Last Name:SIMPKINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MHR/MRC
Mailing Address - Street 1:4528 S SHERIDAN RD STE 113
Mailing Address - Street 2:4528 S. SHERIDAN RD, STE 113, TULSA OK 74145
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-1101
Mailing Address - Country:US
Mailing Address - Phone:918-282-5363
Mailing Address - Fax:918-282-5363
Practice Address - Street 1:448 36TH AVE NW STE 101
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-4743
Practice Address - Country:US
Practice Address - Phone:888-573-7792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 1041C0700X, 171M00000X, 225400000X, 251B00000X, 101YP2500X, 101YA0400X
OK21448101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No251B00000XAgenciesCase Management
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1245549567OtherOKLAHOMA HEALTH CARE AUTHORITY
OK200242130AOtherOHCA SOONERCARE PROVIDER
OK1245549567OtherOKLAHOMA HEALTH CARE AUTHORITY