| Bridge Of Light Llc | |
|
4512 Sunnyview Dr Apt 178 Oklahoma City OK 73135-3163 | |
| (443) 991-1582 | |
| Not Available |
| Full Name | Bridge Of Light Llc |
|---|---|
| Speciality | Psychologist - Counseling |
| Location | 4512 Sunnyview Dr Apt 178, Oklahoma City, Oklahoma |
| Authorized Official Name and Position | Xander Faison (OWNER) |
| Authorized Official Contact | 4439911582 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bridge Of Light Llc 4512 Sunnyview Dr Apt 178 Oklahoma City OK 73135-3163 Ph: (443) 991-1582 | Bridge Of Light Llc 4512 Sunnyview Dr Apt 178 Oklahoma City OK 73135-3163 Ph: (443) 991-1582 |
| NPI Number | 1285453969 |
|---|---|
| Provider Enumeration Date | 10/09/2024 |
| Last Update Date | 10/09/2024 |
| Certification Date | 10/09/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285453969 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC1900X | Psychologist - Counseling | (* (Not Available)) | Primary |
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