Healthcare Provider Details

I. General information

NPI: 1821894866
Provider Name (Legal Business Name): INNER CIRCLE MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2025
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 ADAMS RD STE 110
NORMAN OK
73069-1032
US

IV. Provider business mailing address

2920 ADAMS RD STE 110
NORMAN OK
73069-1032
US

V. Phone/Fax

Practice location:
  • Phone: 405-268-1143
  • Fax: 405-857-3119
Mailing address:
  • Phone: 405-268-1143
  • Fax: 405-857-3119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KATELYN AMANDA COOPER
Title or Position: OWNER
Credential:
Phone: 405-215-9221