Healthcare Provider Details

I. General information

NPI: 1295551422
Provider Name (Legal Business Name): AMAZE COUNSELING AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2024
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5708 NW 132ND ST STE C
OKLAHOMA CITY OK
73142-4430
US

IV. Provider business mailing address

PO BOX 720935
OKLAHOMA CITY OK
73172-0935
US

V. Phone/Fax

Practice location:
  • Phone: 405-400-1169
  • Fax:
Mailing address:
  • Phone: 405-400-1169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name: STACIE MAZE
Title or Position: LICENSED PROFESSIONAL COUNSELOR/OWN
Credential: LPC, LMHC
Phone: 405-400-1169