LIBERTAD WELLNESS CENTER LLC NPI 1295583508

NPI Information

  • NPI: 1295583508
  • Provider Name: LIBERTAD WELLNESS CENTER LLC
  • Classification: Nurse Practitioner - 363LP0808X
  • Specialization: Psychiatric/Mental Health
  • Entity Type: Organization
  • Address: 2915 N CLASSEN BLVD STE 120-F509
    OKLAHOMA CITY, OK
    ZIP 73106
  • Phone: (405) 689-9303

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NPI Details

LIBERTAD WELLNESS CENTER LLC is a psychiatric/mental health nurse practitioner in Oklahoma City, OK. LIBERTAD WELLNESS CENTER LLC NPI is 1295583508. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

2915 N CLASSEN BLVD STE 120-F509
OKLAHOMA CITY, OK
ZIP 73106-400
Phone: (405) 689-9303
Fax: (405) 229-5071

The provider's authorized official is Prudencia Ijeoma Tankeu .
The authorized official title is Manager and has the following contact phone number (405) 689-9303.

The enumeration date for this NPI number is 5/10/2024 and was last updated on 9/4/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1171400000XHealth and Wellness CoachNo
2261QM0801XClinic/CenterMental Health (Including Community Mental Health Center)No
3261QR0405XClinic/CenterRehabilitation, Substance Use DisorderNo
4363LP0808XNurse PractitionerPsychiatric/Mental HealthYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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