Healthcare Provider Details

I. General information

NPI: 1992646392
Provider Name (Legal Business Name): RISE WELLNES & RESOURCE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7955 S 296TH EAST AVE
BROKEN ARROW OK
74014-5857
US

IV. Provider business mailing address

7122 S SHERIDAN RD STE 2 PMB 1066
TULSA OK
74133-2775
US

V. Phone/Fax

Practice location:
  • Phone: 918-606-5575
  • Fax:
Mailing address:
  • Phone: 918-606-5575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. WINFRED ANDREW CHILES II
Title or Position: MANAGING MEMBER
Credential: LCSW
Phone: 918-606-5575