Healthcare Provider Details

I. General information

NPI: 1497926471
Provider Name (Legal Business Name): DEBORAH SUE VANDERPOOL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 LENAPE DR
NOWATA OK
74048-4403
US

IV. Provider business mailing address

PO BOX 858
OOLOGAH OK
74053-0858
US

V. Phone/Fax

Practice location:
  • Phone: 918-273-7504
  • Fax: 918-273-3451
Mailing address:
  • Phone: 918-833-0571
  • Fax: 918-342-6815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4693
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4693
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: