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General NPI Number Information
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NPI Number | 1225815624
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Entity Type | Organization
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Legal Business Name | BRAIN GARDEN COUNSELING LLC
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Dates
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Enumeration Date | 09/11/2023
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Last Update Date | 09/11/2023
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Provider Practice Location Address
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Address Line | 9800 N 100TH EAST AVE
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City | OWASSO
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State | OK
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Zip | 74055-6491
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Country | US
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Telephone | 918-609-3006
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Fax |
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Provider Business Mailing Address
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Address Line | 9800 N 100TH EAST AVE
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City | OWASSO
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State | OK
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Zip | 74055-6491
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Country | US
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Telephone | 918-609-3006
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Fax |
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Authorized Official
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Title or Position | OWNER / LICENSED COUNSELOR
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Name | MRS. MARY THOMAS
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Credential | LPC
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Telephone | 918-609-3006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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