Healthcare Provider Details

I. General information

NPI: 1477765675
Provider Name (Legal Business Name): REBEL COURTNEY BUERSMEYER LADC, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2932 NW 122ND ST SUITE 20
OKLAHOMA CITY OK
73120-1957
US

IV. Provider business mailing address

PO BOX 20776
OKLAHOMA CITY OK
73156-0776
US

V. Phone/Fax

Practice location:
  • Phone: 405-242-5305
  • Fax: 405-242-5345
Mailing address:
  • Phone: 405-249-8734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number544
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number891
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: