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General NPI Number Information
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NPI Number | 1912612334
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Entity Type | Organization
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Legal Business Name | PRIME MENTAL HEALTH, LLC
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Dates
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Enumeration Date | 01/19/2023
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Last Update Date | 01/19/2023
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Provider Practice Location Address
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Address Line | 6001 NW 63RD ST # 32424
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City | OKLAHOMA CITY
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State | OK
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Zip | 73132-7504
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Country | US
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Telephone | 405-456-9688
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 32424
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City | OKLAHOMA CITY
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State | OK
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Zip | 73123-0624
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Country | US
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Telephone | 405-456-9688
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHELLE RUDESILL
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Credential | LPC, CRC
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Telephone | 405-456-9688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225C00000X
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Taxonomy Name | Rehabilitation Counselor
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License Number |
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License Number State |
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Taxonomy #2
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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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