Healthcare Provider Details

I. General information

NPI: 1790571669
Provider Name (Legal Business Name): RISE CENTER FOR MENTAL HEALTH AND HEALING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2025
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10904 BLUE SKY DR
MIDWEST CITY OK
73130-2122
US

IV. Provider business mailing address

10904 BLUE SKY DR
MIDWEST CITY OK
73130-2122
US

V. Phone/Fax

Practice location:
  • Phone: 405-301-4454
  • Fax:
Mailing address:
  • Phone: 405-301-4454
  • 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: ASHLEE DENEE TOLLISON
Title or Position: OWNER/PROVIDER
Credential: LPC
Phone: 405-301-4454