Provider Demographics
NPI:1457852659
Name:MINDFUL PSYCHIATRY, PC
Entity Type:Organization
Organization Name:MINDFUL PSYCHIATRY, PC
Other - Org Name:MINDFUL PSYCHIATRY, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:OLIVER
Authorized Official - Last Name:SKELTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-701-3770
Mailing Address - Street 1:2831 E 103RD PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-5606
Mailing Address - Country:US
Mailing Address - Phone:918-701-3770
Mailing Address - Fax:918-701-3779
Practice Address - Street 1:5014 E 101ST ST STE 200
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-5803
Practice Address - Country:US
Practice Address - Phone:918-701-3770
Practice Address - Fax:918-701-3779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-22
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK297072084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK29707OtherNOT ENROLLED