Healthcare Provider Details

I. General information

NPI: 1215878053
Provider Name (Legal Business Name): CHURCH OF THE WAYWARD SOULS DBA WAYWARD COMMUNITY CASE MANAGMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2026
Last Update Date: 04/04/2026
Certification Date: 04/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

637 WELSTON CIR
NORMAN OK
73071-4108
US

IV. Provider business mailing address

637 WELSTON CIR
NORMAN OK
73071-4108
US

V. Phone/Fax

Practice location:
  • Phone: 405-246-8262
  • Fax: 405-246-8262
Mailing address:
  • Phone: 405-246-8262
  • Fax: 405-246-8262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MICHEAL MARSH
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 405-246-8262