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General NPI Number Information
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NPI Number | 1164826145
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Entity Type | Individual
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Provider Name | REBECCA MILD LPC
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Gender | Female
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Dates
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Enumeration Date | 10/20/2014
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Last Update Date | 10/20/2014
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Provider Practice Location Address
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Address Line | 4811 GAILLARDIA PKWY SUITE 110
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City | OKLAHOMA CITY
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State | OK
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Zip | 73142-1874
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Country | US
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Telephone | 405-403-1932
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 COPELAND WAY
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City | EDMOND
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State | OK
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Zip | 73025-1362
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1368
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License Number State | OK
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