Healthcare Provider Details

I. General information

NPI: 1649878679
Provider Name (Legal Business Name): PAULA MITCHELL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2020
Last Update Date: 10/12/2020
Certification Date: 09/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3930 INDIAN POINT CIR
NORMAN OK
73026-8634
US

IV. Provider business mailing address

3930 INDIAN POINT CIR
NORMAN OK
73026-8634
US

V. Phone/Fax

Practice location:
  • Phone: 918-852-7208
  • Fax:
Mailing address:
  • Phone: 918-852-7208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: PAULA E MITCHELL
Title or Position: OWNER
Credential: CCC-SLP
Phone: 918-852-7208