Provider Demographics
NPI:1427458165
Name:DEEP THOUGHTS AND WELLNESS CENTER
Entity type:Organization
Organization Name:DEEP THOUGHTS AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RANADA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-609-6595
Mailing Address - Street 1:5505 MAIN ST
Mailing Address - Street 2:SUITE 102& 103
Mailing Address - City:DEL CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73115-5509
Mailing Address - Country:US
Mailing Address - Phone:405-609-6595
Mailing Address - Fax:405-609-6575
Practice Address - Street 1:5505 MAIN ST
Practice Address - Street 2:SUITE 102& 103
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-5509
Practice Address - Country:US
Practice Address - Phone:405-609-6595
Practice Address - Fax:405-609-6575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-29
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK251B000000X251B00000X
OK251S0000000X251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK75740OtherCARF ACCREDITATION