Organization
BRIDGE OF LIGHT LLC
Active
Other names
Bridge of Light Inc
Organization subpart
No
Provider details
NPI number
Authorized official
MS. XANDER D FAISON LPC (OWNER/CLINICAL DIRECTOR)
(443) 991-1582
Entity
Organization
Contact information
Practice address
9130 S WALKER AVE, OKLAHOMA CITY, OK 73139-8508
(405) 463-9796
Mailing address
4512 SUNNYVIEW DR APT 178, OKLAHOMA CITY, OK 73135-3163
(443) 991-1582
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
08/05/2024
Last updated
08/05/2024
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