=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275323651
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE OAK HAVEN GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2025
-----------------------------------------------------
Last Update Date | 05/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 624 W 18TH ST
-----------------------------------------------------
City | EDMOND
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73013-3631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-315-4593
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2904 LONGMEADOW
-----------------------------------------------------
City | EDMOND
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73003-3065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-315-0459
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | AMY HUESMAN
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 405-315-4593
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------