Provider Demographics
NPI:1750713863
Name:SELLS, ANITA WYLNN
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:WYLNN
Last Name:SELLS
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 1:1621 N 23RD WEST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74127-2201
Mailing Address - Country:US
Mailing Address - Phone:918-361-5086
Mailing Address - Fax:
Practice Address - Street 1:1621 N 23RD WEST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127-2201
Practice Address - Country:US
Practice Address - Phone:918-361-5086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health