Healthcare Provider Details

I. General information

NPI: 1235867607
Provider Name (Legal Business Name): META MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2022
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 E CENTRAL AVE STE A
MIAMI OK
74354-7013
US

IV. Provider business mailing address

218 E CENTRAL AVE STE A
MIAMI OK
74354-7013
US

V. Phone/Fax

Practice location:
  • Phone: 918-919-3298
  • Fax:
Mailing address:
  • Phone: 918-919-3298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
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: CARLA WOLF
Title or Position: THERAPIST
Credential: LPC
Phone: 417-621-5965