Healthcare Provider Details

I. General information

NPI: 1871069245
Provider Name (Legal Business Name): SOUTHERN NAZARENE UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2018
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6612 NW 42ND ST
BETHANY OK
73008-2764
US

IV. Provider business mailing address

6612 NW 42ND ST
BETHANY OK
73008-2764
US

V. Phone/Fax

Practice location:
  • Phone: 405-717-6200
  • Fax:
Mailing address:
  • Phone: 405-717-6200
  • 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: MRS. HOLLY N SAPP
Title or Position: EXECUTIVE CLINICAL DIRECTOR
Credential: LPC
Phone: 405-717-6200