Healthcare Provider Details

I. General information

NPI: 1013549559
Provider Name (Legal Business Name): ELIJAH FREELS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2020
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 N LINCOLN BLVD
OKLAHOMA CITY OK
73105-5104
US

IV. Provider business mailing address

7777 E US HIGHWAY 66
EL RENO OK
73036-9125
US

V. Phone/Fax

Practice location:
  • Phone: 405-422-8800
  • Fax:
Mailing address:
  • Phone: 405-422-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number21949
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: