Healthcare Provider Details

I. General information

NPI: 1407793565
Provider Name (Legal Business Name): THE EVERBLOOM INSTITUTE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 N BROADWAY STE 104
EDMOND OK
73034-3642
US

IV. Provider business mailing address

320 N BROADWAY STE 104
EDMOND OK
73034-3642
US

V. Phone/Fax

Practice location:
  • Phone: 405-653-8012
  • Fax:
Mailing address:
  • Phone: 405-653-8012
  • 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: TARA ANN SMITH
Title or Position: DIRECTOR
Credential: ED.S, LPC
Phone: 405-653-7269