Healthcare Provider Details

I. General information

NPI: 1124640180
Provider Name (Legal Business Name): ALEXSANDRA LYNN PORTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXSANDRA LYNN POWELL

II. Dates (important events)

Enumeration Date: 05/13/2020
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 ALAMEDA ST
NORMAN OK
73071-5229
US

IV. Provider business mailing address

2121 NATCHEZ DR
NORMAN OK
73071-2025
US

V. Phone/Fax

Practice location:
  • Phone: 405-360-5100
  • Fax:
Mailing address:
  • Phone: 570-328-1993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: