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General NPI Number Information
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NPI Number | 1023453602
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Entity Type | Organization
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Legal Business Name | BISON FAMILY THERAPY INSTITUTE, PLLC
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Dates
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Enumeration Date | 05/08/2013
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Last Update Date | 08/29/2022
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Provider Practice Location Address
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Address Line | 1601 N KICKAPOO AVE STE 900
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City | SHAWNEE
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State | OK
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Zip | 74804-4313
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Country | US
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Telephone | 405-585-6413
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Fax | 405-395-0255
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Provider Business Mailing Address
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Address Line | 2007 N MINNESOTA AVE
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City | SHAWNEE
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State | OK
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Zip | 74804-3024
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Country | US
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Telephone | 405-226-0644
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Fax | 405-395-0255
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Authorized Official
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Title or Position | OWNER
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Name | DR. CANAAN CRANE
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Credential | PHD, LMFT
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Telephone | 405-226-0644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 783
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License Number State | OK
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