Provider Demographics
NPI:1124215942
Name:BESHARA, IRIS PADILLA (LCSW)
Entity type:Individual
Prefix:
First Name:IRIS
Middle Name:PADILLA
Last Name:BESHARA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 S COLUMBIA AVE STE 480
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-3514
Mailing Address - Country:US
Mailing Address - Phone:918-498-6708
Mailing Address - Fax:
Practice Address - Street 1:2121 S COLUMBIA AVE STE 480
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-3514
Practice Address - Country:US
Practice Address - Phone:918-498-6708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK67111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical