Healthcare Provider Details

I. General information

NPI: 1629930961
Provider Name (Legal Business Name): MASYN NICHELLE GRIFFITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2025
Last Update Date: 09/13/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4103 S YALE AVE STE B
TULSA OK
74135-6002
US

IV. Provider business mailing address

8329 E 163RD ST S
BIXBY OK
74008-5335
US

V. Phone/Fax

Practice location:
  • Phone: 918-992-2335
  • Fax: 918-392-3471
Mailing address:
  • Phone: 918-992-2335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: