Provider Demographics
NPI:1730433368
Name:WINSTON, SEAN TYRELL
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:TYRELL
Last Name:WINSTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5913 N GARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74126-2203
Mailing Address - Country:US
Mailing Address - Phone:918-812-9004
Mailing Address - Fax:
Practice Address - Street 1:5913 N GARRISON AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74126-2203
Practice Address - Country:US
Practice Address - Phone:918-812-9004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health