Healthcare Provider Details

I. General information

NPI: 1063774131
Provider Name (Legal Business Name): MINDY MEADOR MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2012
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 E 31ST ST
TULSA OK
74135-5012
US

IV. Provider business mailing address

5310 E 31ST ST
TULSA OK
74135-5012
US

V. Phone/Fax

Practice location:
  • Phone: 918-600-3100
  • Fax: 918-560-1399
Mailing address:
  • Phone: 918-600-3100
  • Fax: 918-560-1399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5432
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: