Healthcare Provider Details

I. General information

NPI: 1003173691
Provider Name (Legal Business Name): MAKING A DIFFERENCE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2012
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 N UNIVERSITY AVE
ENID OK
73701-4653
US

IV. Provider business mailing address

129 N UNIVERSITY AVE
ENID OK
73701-4653
US

V. Phone/Fax

Practice location:
  • Phone: 580-233-5900
  • Fax: 580-701-4312
Mailing address:
  • Phone: 580-233-5900
  • Fax: 580-701-4312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KELLI LYNN OSBURN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 580-233-5900