Provider Demographics
NPI:1467829267
Name:ABUNDANT LIVING
Entity Type:Organization
Organization Name:ABUNDANT LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED NEUROFEEDBACK
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAAB
Authorized Official - Suffix:
Authorized Official - Credentials:MA COUNSELING, BCN
Authorized Official - Phone:918-853-7793
Mailing Address - Street 1:2526 E 71ST ST
Mailing Address - Street 2:SUITE J
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-5538
Mailing Address - Country:US
Mailing Address - Phone:918-853-7793
Mailing Address - Fax:
Practice Address - Street 1:2526 E 71ST ST
Practice Address - Street 2:SUITE J
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-5538
Practice Address - Country:US
Practice Address - Phone:918-853-7793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-27
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health