Healthcare Provider Details

I. General information

NPI: 1497438204
Provider Name (Legal Business Name): MIND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2023
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 S LIONS AVE
BROKEN ARROW OK
74012-6615
US

IV. Provider business mailing address

1840 S LIONS AVE
BROKEN ARROW OK
74012-6615
US

V. Phone/Fax

Practice location:
  • Phone: 918-574-5124
  • Fax:
Mailing address:
  • Phone: 918-574-5124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE SUE MCQUARTERS
Title or Position: NURSE PRACTITIONER
Credential: APRN
Phone: 918-574-5124