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General NPI Number Information
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NPI Number | 1992646392
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Entity Type | Organization
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Legal Business Name | RISE WELLNES & RESOURCE CENTER, LLC
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Dates
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Enumeration Date | 04/02/2026
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Last Update Date | 04/02/2026
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Provider Practice Location Address
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Address Line | 7955 S 296TH EAST AVE
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City | BROKEN ARROW
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State | OK
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Zip | 74014-5857
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Country | US
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Telephone | 918-606-5575
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Fax |
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Provider Business Mailing Address
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Address Line | 7122 S SHERIDAN RD STE 2 PMB 1066
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City | TULSA
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State | OK
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Zip | 74133-2775
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Country | US
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Telephone | 918-606-5575
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. WINFRED ANDREW CHILES II
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Credential | LCSW
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Telephone | 918-606-5575
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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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