MEDICARE: MS. BENAY FOSSEY LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor		OK

General Provider Information

NPI Number	:	1083783195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BENAY FOSSEY LMFT

Provider Business Mailing Address
First Line	:	1704 NW 21ST ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73106-3808
Country	:	US
Telephone Number	:	405-795-3597
Fax Number	:

Provider Business Practice Location Address
First Line	:	1704 NW 21ST ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73106-3808
Country	:	US
Telephone Number	:	405-795-3597
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	12/06/2019

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