Healthcare Provider Details

I. General information

NPI: 1487352688
Provider Name (Legal Business Name): PSYCH WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2023
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2268 36TH AVE NW STE 120
NORMAN OK
73072-3287
US

IV. Provider business mailing address

2268 36TH AVE NW STE 120
NORMAN OK
73072-3287
US

V. Phone/Fax

Practice location:
  • Phone: 405-876-8118
  • Fax: 936-244-4621
Mailing address:
  • Phone: 405-876-8118
  • Fax: 936-244-4621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK DANIEL HOLSEY
Title or Position: PHYSICIAN
Credential: DO
Phone: 405-876-8118