MEDICARE: ABUNDANT LIFE WHOLE PERSON WELLNESS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1639028996
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABUNDANT LIFE WHOLE PERSON WELLNESS LLC

Provider Business Mailing Address
First Line	:	5151 OAK TIMBER DR
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74131-2654
Country	:	US
Telephone Number	:	918-216-2605
Fax Number	:	918-216-2606

Provider Business Practice Location Address
First Line	:	3150 E 41ST ST STE 108A
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74105-3739
Country	:	US
Telephone Number	:	918-216-2605
Fax Number	:	918-216-2606

Authorized Official
Title or Position	:	COUNSELOR
Name	:	SALLY MARIE SULLIVAN
Credential	:	MA, LPC
Telephone Number	:	918-216-2605

Provider Enumeration Date	:	01/28/2026
Last Update Date	:	06/05/2026

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