=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770174989
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MINDSET BEHAVIORAL HEALTH PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2021
-----------------------------------------------------
Last Update Date | 01/30/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5800 S LEWIS AVE STE 275
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74105-7100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-808-6995
-----------------------------------------------------
Fax | 918-514-7785
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5800 S LEWIS AVE STE 275
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74105-7100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-808-6995
-----------------------------------------------------
Fax | 918-514-7785
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MS. AMY TURNER
-----------------------------------------------------
Credential | LPC, LADC
-----------------------------------------------------
Telephone | 918-808-6995
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------