Healthcare Provider Details

I. General information

NPI: 1235047457
Provider Name (Legal Business Name): KALEIDOSCOPE COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2026
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3442 EDGEWOOD RD
ARDMORE OK
73401-7897
US

IV. Provider business mailing address

3442 EDGEWOOD RD
ARDMORE OK
73401-7897
US

V. Phone/Fax

Practice location:
  • Phone: 580-768-1634
  • Fax:
Mailing address:
  • Phone: 580-768-1634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MIRANDA BOWMAN
Title or Position: THERAPIST
Credential: MSHR, CRC, NCC, LPC
Phone: 580-768-1634