Provider Demographics
NPI:1588875355
Name:FAMILY-INTEGRATED THERAPY SERVICES, PLLC
Entity type:Organization
Organization Name:FAMILY-INTEGRATED THERAPY SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:HARROD
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC SLP
Authorized Official - Phone:918-850-7465
Mailing Address - Street 1:4870 S LEWIS AVE
Mailing Address - Street 2:SUITE 245
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-5151
Mailing Address - Country:US
Mailing Address - Phone:918-850-7465
Mailing Address - Fax:918-779-4571
Practice Address - Street 1:4870 S LEWIS AVE
Practice Address - Street 2:SUITE 245
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-5151
Practice Address - Country:US
Practice Address - Phone:918-850-7465
Practice Address - Fax:918-779-4571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK421261QM2500X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200036380AMedicaid
OK200101890AMedicaid