Healthcare Provider Details

I. General information

NPI: 1780516195
Provider Name (Legal Business Name): MIKAYLA THOMPSON LMSW-P U/S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MIKAYLA B JENSON

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 S BROADWAY AVE STE 106
ADA OK
74820-5818
US

IV. Provider business mailing address

PO BOX 662
PURCELL OK
73080-0662
US

V. Phone/Fax

Practice location:
  • Phone: 580-235-0210
  • Fax:
Mailing address:
  • Phone: 405-527-1785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: