Healthcare Provider Details

I. General information

NPI: 1992609184
Provider Name (Legal Business Name): SERENE INTEGRATED BEHAVIORAL HEALTH WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E CLARK BASS BLVD
MCALESTER OK
74501-4209
US

IV. Provider business mailing address

1 E CLARK BASS BLVD
MCALESTER OK
74501-4209
US

V. Phone/Fax

Practice location:
  • Phone: 405-409-8018
  • Fax:
Mailing address:
  • Phone: 405-409-8018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: MUJIDAT SEIDU
Title or Position: APRN
Credential: DNP, PMHNP-BC
Phone: 713-689-0935