Basic Information
| Provider Information | |||||||||
| NPI: | 1700544913 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MINDFUL BISON INCORPORATED | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3325 WOOD VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730713689 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4058207281 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4330 ADAMS RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730691007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057018400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2021 | ||||||||
| LastUpdateDate: | 12/05/2021 | ||||||||
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| AuthorizedOfficialLastName: | POWERS | ||||||||
| AuthorizedOfficialFirstName: | DESHIA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4058207281 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LPC | ||||||||
| NPICertificationDate: | 12/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.