Provider Demographics
NPI:1164829198
Name:ELROD-EDWARDS, RACHEAL
Entity type:Individual
Prefix:
First Name:RACHEAL
Middle Name:
Last Name:ELROD-EDWARDS
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 1:6202 S LEWIS AVE STE B
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-1064
Mailing Address - Country:US
Mailing Address - Phone:918-505-4866
Mailing Address - Fax:844-257-0427
Practice Address - Street 1:6202 S LEWIS AVE STE B
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-1064
Practice Address - Country:US
Practice Address - Phone:918-505-4866
Practice Address - Fax:844-257-0427
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-19
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist