Provider Demographics
NPI:1366139040
Name:COLLECTIVE HEALTH & WELLNESS
Entity type:Organization
Organization Name:COLLECTIVE HEALTH & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIERRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:405-209-2083
Mailing Address - Street 1:9325 EMILY LN
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-4330
Mailing Address - Country:US
Mailing Address - Phone:405-209-2083
Mailing Address - Fax:888-875-1829
Practice Address - Street 1:1330 N CLASSEN BLVD STE 116
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-6834
Practice Address - Country:US
Practice Address - Phone:405-953-6888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-21
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health