Healthcare Provider Details

I. General information

NPI: 1891817664
Provider Name (Legal Business Name): RUSTLING WINDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 WEST MAIN
WILBURTON OK
74578
US

IV. Provider business mailing address

211 WEST MAIN
WILBURTON OK
74578
US

V. Phone/Fax

Practice location:
  • Phone: 918-465-1100
  • Fax: 918-465-5658
Mailing address:
  • Phone: 918-465-1100
  • Fax: 918-465-5658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. BRENDA REANA BUMPHUS
Title or Position: ADMINISTRATOR
Credential:
Phone: 918-426-1076