Healthcare Provider Details

I. General information

NPI: 1992028146
Provider Name (Legal Business Name): MYRLANE F. MENDENHALL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2010
Last Update Date: 09/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 E 15TH ST STE 102
EDMOND OK
73013-5043
US

IV. Provider business mailing address

501 E 15TH ST STE 102
EDMOND OK
73013-5043
US

V. Phone/Fax

Practice location:
  • Phone: 405-206-3007
  • Fax: 405-285-9877
Mailing address:
  • Phone: 405-206-3007
  • Fax: 405-285-9877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: