Healthcare Provider Details

I. General information

NPI: 1871601559
Provider Name (Legal Business Name): SUNDANCE COUNSELING & MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 N FLOOD AVE
NORMAN OK
73069-7642
US

IV. Provider business mailing address

930 N FLOOD AVE
NORMAN OK
73069-7642
US

V. Phone/Fax

Practice location:
  • Phone: 405-321-3719
  • Fax: 405-364-3209
Mailing address:
  • Phone: 405-321-3719
  • Fax: 405-364-3209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JULIA J IRWIN
Title or Position: CEO
Credential: M.D.
Phone: 405-928-2044