Provider Demographics
NPI:1871601559
Name:SUNDANCE COUNSELING & MENTAL HEALTH
Entity type:Organization
Organization Name:SUNDANCE COUNSELING & MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:IRWIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-928-2044
Mailing Address - Street 1:930 N FLOOD AVE
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-7642
Mailing Address - Country:US
Mailing Address - Phone:405-321-3719
Mailing Address - Fax:405-364-3209
Practice Address - Street 1:930 N FLOOD AVE
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-7642
Practice Address - Country:US
Practice Address - Phone:405-321-3719
Practice Address - Fax:405-364-3209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty