Provider Demographics
NPI:1194405704
Name:FULL LIFE BEHAVIORAL SYSTEMS, INC.
Entity type:Organization
Organization Name:FULL LIFE BEHAVIORAL SYSTEMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:918-639-6492
Mailing Address - Street 1:PO BOX 690571
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74169-0571
Mailing Address - Country:US
Mailing Address - Phone:918-636-6576
Mailing Address - Fax:
Practice Address - Street 1:3015 E SKELLY DR STE 135
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-6344
Practice Address - Country:US
Practice Address - Phone:918-636-6476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health