Healthcare Provider Details

I. General information

NPI: 1770327397
Provider Name (Legal Business Name): SONGBIRD PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2024
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13334 S 21ST ST
BIXBY OK
74008-1040
US

IV. Provider business mailing address

13334 S 21ST ST
BIXBY OK
74008-1040
US

V. Phone/Fax

Practice location:
  • Phone: 936-404-7344
  • Fax:
Mailing address:
  • Phone: 936-404-7344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. AMANDA ANNETTE SPEARS
Title or Position: OWNER/SOCIAL WORKER
Credential: LCSW, LICSW
Phone: 936-404-7344