Healthcare Provider Details

I. General information

NPI: 1376123646
Provider Name (Legal Business Name): CALM MIND MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 05/13/2021
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8596 E 101ST ST STE D
TULSA OK
74133-7037
US

IV. Provider business mailing address

8596 E 101ST ST STE D
TULSA OK
74133-7037
US

V. Phone/Fax

Practice location:
  • Phone: 830-370-6939
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LACY DEANE
Title or Position: OWNER/THERAPIST
Credential: LPC
Phone: 830-370-6939