Provider Demographics
NPI:1770882755
Name:ROKNI, PHOENIX ALI (MS, LADC, LPC)
Entity type:Individual
Prefix:MR
First Name:PHOENIX
Middle Name:ALI
Last Name:ROKNI
Suffix:
Gender:M
Credentials:MS, LADC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 S HARVARD AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-6124
Mailing Address - Country:US
Mailing Address - Phone:918-749-1841
Mailing Address - Fax:918-749-1841
Practice Address - Street 1:3010 S HARVARD AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-6124
Practice Address - Country:US
Practice Address - Phone:918-749-1841
Practice Address - Fax:918-749-1841
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OK1092101YA0400X
OK5683101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)