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General NPI Number Information
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NPI Number | 1578061578
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Entity Type | Organization
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Legal Business Name | LIFE MIND , PLLC
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Dates
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Enumeration Date | 01/25/2018
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Last Update Date | 01/25/2018
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Provider Practice Location Address
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Address Line | 2624 E 22ND PL
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City | TULSA
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State | OK
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Zip | 74114-3131
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Country | US
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Telephone | 918-760-1098
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Fax |
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Provider Business Mailing Address
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Address Line | 2624 E 22ND PL
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City | TULSA
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State | OK
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Zip | 74114-3131
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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 | THERAPIST
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Name | LINDA BARNUM
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Credential | LPC
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Telephone | 918-760-1098
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 4777
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 4777
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License Number State | OK
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