| Bridge Of Light Llc | |
|
9130 S Walker Ave Oklahoma City OK 73139-8508 | |
| (405) 463-9796 | |
| Not Available |
| Full Name | Bridge Of Light Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 9130 S Walker Ave, Oklahoma City, Oklahoma |
| Authorized Official Name and Position | Xander D Faison (OWNER/CLINICAL DIRECTOR) |
| 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 9130 S Walker Ave Oklahoma City OK 73139-8508 Ph: (405) 463-9796 |
| NPI Number | 1013747120 |
|---|---|
| Provider Enumeration Date | 08/05/2024 |
| Last Update Date | 08/05/2024 |
| Certification Date | 08/03/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013747120 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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