Basic Information
| Provider Information | |||||||||
| NPI: | 1891817664 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RUSTLING WINDS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 211 WEST MAIN | ||||||||
| Address2: | |||||||||
| City: | WILBURTON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74578 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184651100 | ||||||||
| FaxNumber: | 9184655658 | ||||||||
| Practice Location | |||||||||
| Address1: | 211 WEST MAIN | ||||||||
| Address2: | |||||||||
| City: | WILBURTON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74578 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184651100 | ||||||||
| FaxNumber: | 9184655658 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BUMPHUS | ||||||||
| AuthorizedOfficialFirstName: | BRENDA | ||||||||
| AuthorizedOfficialMiddleName: | REANA | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 9184261076 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.