Healthcare Provider Details

I. General information

NPI: 1912820887
Provider Name (Legal Business Name): ANGELA MICHELLE WILBOURN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 24TH AVE NW
NORMAN OK
73069-6369
US

IV. Provider business mailing address

302 SW 2ND ST
LINDSAY OK
73052-5404
US

V. Phone/Fax

Practice location:
  • Phone: 405-310-3262
  • Fax:
Mailing address:
  • Phone: 405-756-7282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: