Healthcare Provider Details

I. General information

NPI: 1265291876
Provider Name (Legal Business Name): MIND RENEWAL COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10830 E 45TH ST STE C102
TULSA OK
74146-3805
US

IV. Provider business mailing address

10830 E 45TH ST STE C102
TULSA OK
74146-3805
US

V. Phone/Fax

Practice location:
  • Phone: 539-242-4100
  • Fax: 539-242-4111
Mailing address:
  • Phone: 539-242-4100
  • Fax: 539-242-4111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SARAH THOMAS
Title or Position: OWNER/CLINICAL DIRECTOR
Credential: LPC
Phone: 539-242-4100