MEDICARE: MIND RENEWING THERAPY PLLC

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1871422022
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIND RENEWING THERAPY PLLC

Provider Business Mailing Address
First Line	:	2505 NE 19TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73111-1813
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2505 NE 19TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73111-1813
Country	:	US
Telephone Number	:	405-326-1176
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KIRSTEN LEE
Credential	:	LPC
Telephone Number	:	405-317-5448

Provider Enumeration Date	:	05/14/2026
Last Update Date	:	05/14/2026

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