Healthcare Provider Details

I. General information

NPI: 1376379370
Provider Name (Legal Business Name): MINDY HALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 W EDMOND RD
EDMOND OK
73003-5600
US

IV. Provider business mailing address

1022 W GEMINI RD
EDMOND OK
73003-5808
US

V. Phone/Fax

Practice location:
  • Phone: 405-216-3391
  • Fax:
Mailing address:
  • Phone: 479-522-0887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-90287
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: