Healthcare Provider Details

I. General information

NPI: 1548576622
Provider Name (Legal Business Name): STEPHANIE BUELL M.A. LPC, LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2010
Last Update Date: 09/30/2021
Certification Date: 09/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21380 N FOSSIL CREEK DR
EDMOND OK
73012-9066
US

IV. Provider business mailing address

21380 N FOSSIL CREEK DR
EDMOND OK
73012-9066
US

V. Phone/Fax

Practice location:
  • Phone: 405-216-3312
  • Fax:
Mailing address:
  • Phone: 405-216-3312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1045
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number04987
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: