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General NPI Number Information
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NPI Number | 1700544913
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Entity Type | Organization
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Legal Business Name | MINDFUL BISON INCORPORATED
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Dates
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Enumeration Date | 12/05/2021
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Last Update Date | 12/05/2021
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Provider Practice Location Address
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Address Line | 4330 ADAMS RD STE 100
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City | NORMAN
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State | OK
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Zip | 73069-1007
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Country | US
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Telephone | 405-701-8400
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Fax |
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Provider Business Mailing Address
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Address Line | 3325 WOOD VALLEY RD
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City | NORMAN
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State | OK
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Zip | 73071-3689
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Country | US
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Telephone | 405-820-7281
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DESHIA POWERS
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Credential | LPC
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Telephone | 405-820-7281
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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 |
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License Number State |
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