Provider Demographics
NPI:1699419358
Name:THOMASON, HOLLI PAIGE
Entity type:Individual
Prefix:
First Name:HOLLI
Middle Name:PAIGE
Last Name:THOMASON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1748 E 14TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4630
Mailing Address - Country:US
Mailing Address - Phone:918-829-4299
Mailing Address - Fax:
Practice Address - Street 1:1616 N GILCREASE MUSEUM RD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127-2101
Practice Address - Country:US
Practice Address - Phone:918-862-2083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker