Healthcare Provider Details

I. General information

NPI: 1700590650
Provider Name (Legal Business Name): ELIZABETH W BULMER COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2023
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 S STATE ST STE 100
EDMOND OK
73013-3507
US

IV. Provider business mailing address

1601 S STATE ST STE 100
EDMOND OK
73013-3507
US

V. Phone/Fax

Practice location:
  • Phone: 405-252-1203
  • Fax: 405-267-4742
Mailing address:
  • Phone: 405-252-1203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH WALT BULMER
Title or Position: PROVIDER
Credential: LCSW
Phone: 832-298-1763