Healthcare Provider Details

I. General information

NPI: 1871422022
Provider Name (Legal Business Name): MIND RENEWING THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 NE 19TH ST
OKLAHOMA CITY OK
73111-1813
US

IV. Provider business mailing address

2505 NE 19TH ST
OKLAHOMA CITY OK
73111-1813
US

V. Phone/Fax

Practice location:
  • Phone: 405-326-1176
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: KIRSTEN LEE
Title or Position: OWNER
Credential: LPC
Phone: 405-317-5448