Healthcare Provider Details

I. General information

NPI: 1689193773
Provider Name (Legal Business Name): RESILIENCE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8988 S SHERIDAN RD STE F
TULSA OK
74133-5035
US

IV. Provider business mailing address

8988 S SHERIDAN RD STE F
TULSA OK
74133-5035
US

V. Phone/Fax

Practice location:
  • Phone: 918-861-4973
  • Fax:
Mailing address:
  • Phone: 918-861-4973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4826
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: RYANNE MITCHELL
Title or Position: OWNER/CLINICAL DIRECTOR
Credential: LPC
Phone: 918-861-4973