Provider Demographics
NPI:1841712593
Name:ABUNDANT LIFE FAMILY THERAPY PLLC
Entity type:Organization
Organization Name:ABUNDANT LIFE FAMILY THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, SAP
Authorized Official - Phone:405-313-8452
Mailing Address - Street 1:10316 GREENBRIAR PL STE 1
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-7649
Mailing Address - Country:US
Mailing Address - Phone:405-313-8452
Mailing Address - Fax:844-272-6181
Practice Address - Street 1:10316 GREENBRIAR PL STE 1
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-7649
Practice Address - Country:US
Practice Address - Phone:405-313-8452
Practice Address - Fax:844-272-6181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1710299250Medicaid
OK1104165174Medicaid