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NPI Code Detail

MEDICARE: MENDING MINDS THERAPEUTIC SOLUTIONS, LLC

MEDICARE: MENDING MINDS THERAPEUTIC SOLUTIONS, LLC
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
1101YM0800XMental Health Counselor
2261QM0850XAdult Mental Health Clinic/Center
3261QM0855XAdolescent and Children Mental Health Clinic/Center
4251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1144822446
Entity Type Code : Organization
Provider Name (Legal Business Name) : MENDING MINDS THERAPEUTIC SOLUTIONS, LLC
Provider Business Mailing Address
First Line : 2021 S AIR DEPOT BLVD
Second Line :
City : MIDWEST CITY
State : OK
Zip : 73110-5523
Country : US
Telephone Number : 405-776-4637
Fax Number : 405-731-9018
Provider Business Practice Location Address
First Line : 2021 S AIR DEPOT BLVD
Second Line :
City : MIDWEST CITY
State : OK
Zip : 73110-5523
Country : US
Telephone Number : 405-776-4637
Fax Number : 405-731-9018
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MR. YAKNO DOUGLAS
Credential : MHR, LPC
Telephone Number : 405-776-4637
Provider Enumeration Date : 11/11/2020
Last Update Date : 11/11/2020

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