Healthcare Provider Details

I. General information

NPI: 1558274647
Provider Name (Legal Business Name): AMY SARGEANT MA, LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 E 19TH ST STE 301A
EDMOND OK
73013-6519
US

IV. Provider business mailing address

4325 PRESERVE PL
EDMOND OK
73034-9267
US

V. Phone/Fax

Practice location:
  • Phone: 405-471-3315
  • Fax:
Mailing address:
  • Phone: 405-471-3315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: