Healthcare Provider Details

I. General information

NPI: 1376875435
Provider Name (Legal Business Name): ASHANTI RENEE MENSAH LADC/CANIDATE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2010
Last Update Date: 01/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3005 NW 63RD ST
OKLAHOMA CITY OK
73116-3603
US

IV. Provider business mailing address

3900 LAWN DR
DEL CITY OK
73115-2022
US

V. Phone/Fax

Practice location:
  • Phone: 405-521-1755
  • Fax:
Mailing address:
  • Phone: 405-514-5191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: