MEDICARE: MINDING MINDS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	302R00000X	Health Maintenance Organization	4256	OK
2	305R00000X	Preferred Provider Organization	4256	OK
3	101YM0800X	Mental Health Counselor	4256	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134427800
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDING MINDS PC

Provider Business Mailing Address
First Line	:	9622 NE 23RD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73141-4204
Country	:	US
Telephone Number	:	405-259-9500
Fax Number	:	405-259-9500

Provider Business Practice Location Address
First Line	:	9622 NE 23RD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73141-4204
Country	:	US
Telephone Number	:	405-259-9500
Fax Number	:	405-259-9500

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. DORA OLOGWARO UWUDIA
Credential	:	LPC
Telephone Number	:	405-259-9500

Provider Enumeration Date	:	03/04/2011
Last Update Date	:	03/04/2011

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Directions to “MINDING MINDS PC ” Practice Location

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