Organization
BREAKING BARRIERS TOGETHER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. XANDER FAISON LMFT (CLINICIAN)
(443) 876-0637
Entity
Organization
Contact information
Practice address
14300 N PENNSYLVANIA AVE APT 326, OKLAHOMA CITY, OK 73134-6063
(405) 568-1338
Mailing address
14300 N PENNSYLVANIA AVE APT 326, OKLAHOMA CITY, OK 73134-6063
(405) 568-1338
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103TF0000X
Family Psychologist
Primary
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0578458974
—
OK
Enumeration date
07/14/2020
Last updated
07/05/2021
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