| Blooming Mind Pllc | |
|
715 W Main St Ste L Jenks OK 74037-3553 | |
| (918) 280-9166 | |
| Not Available |
| Full Name | Blooming Mind Pllc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 715 W Main St Ste L, Jenks, Oklahoma |
| Authorized Official Name and Position | Ashley Woltjer (MENTAL HEALTH THERAPIST) |
| Authorized Official Contact | 9182809166 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Blooming Mind Pllc 715 W Main St Ste L Jenks OK 74037-3553 Ph: (918) 280-9166 | Blooming Mind Pllc 715 W Main St Ste L Jenks OK 74037-3553 Ph: (918) 280-9166 |
| NPI Number | 1376253682 |
|---|---|
| Provider Enumeration Date | 11/28/2022 |
| Last Update Date | 11/28/2022 |
| Certification Date | 11/28/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376253682 | NPI | - | NPPES |
| 200892560A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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