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General NPI Number Information
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NPI Number | 1861142598
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Entity Type | Organization
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Legal Business Name | REDISCOVER YOU
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Dates
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Enumeration Date | 03/25/2022
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Last Update Date | 03/28/2022
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Provider Practice Location Address
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Address Line | 5601 NW 72ND ST. SUITE 260M
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City | WARR ACRES
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State | OK
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Zip | 73132
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Country | US
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Telephone | 405-676-1072
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Fax |
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Provider Business Mailing Address
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Address Line | 5601 NW 72ND ST STE 260M
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City | WARR ACRES
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State | OK
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Zip | 73132-5931
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Country | US
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Telephone | 405-822-4372
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Fax |
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Authorized Official
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Title or Position | OWNER / OPERATOR
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Name | MR. MICHAEL SYLVESTER RADONSKI
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Credential | LCSW
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Telephone | 405-676-1072
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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