Healthcare Provider Details

I. General information

NPI: 1346175270
Provider Name (Legal Business Name): MIND THE GAP THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 NE 53RD ST
OKLAHOMA CITY OK
73105-1832
US

IV. Provider business mailing address

5216 MACKELMAN DR
OKLAHOMA CITY OK
73135-4320
US

V. Phone/Fax

Practice location:
  • Phone: 405-476-1906
  • Fax:
Mailing address:
  • Phone: 405-476-1906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY ANN CONSTABLE
Title or Position: MANAGING MEMBER
Credential: LPC
Phone: 405-476-1906