Provider Demographics
NPI:1700544913
Name:MINDFUL BISON INCORPORATED
Entity Type:Organization
Organization Name:MINDFUL BISON INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DESHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:405-820-7281
Mailing Address - Street 1:3325 WOOD VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-3689
Mailing Address - Country:US
Mailing Address - Phone:405-820-7281
Mailing Address - Fax:
Practice Address - Street 1:4330 ADAMS RD STE 100
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-1007
Practice Address - Country:US
Practice Address - Phone:405-701-8400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-05
Last Update Date:2021-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty