Provider Demographics
NPI:1902523160
Name:SUNRISE WELLNESS, PLLC
Entity Type:Organization
Organization Name:SUNRISE WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER - THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:TINDELL
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:405-885-4755
Mailing Address - Street 1:3120 W BRITTON RD STE 201
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-2038
Mailing Address - Country:US
Mailing Address - Phone:405-885-4755
Mailing Address - Fax:
Practice Address - Street 1:3120 W BRITTON RD STE 201
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-2038
Practice Address - Country:US
Practice Address - Phone:405-885-4755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1861018764Medicaid