Healthcare Provider Details

I. General information

NPI: 1902352545
Provider Name (Legal Business Name): D. JESSE BRUESCH LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6216 S LEWIS AVE STE 180
TULSA OK
74136-1077
US

IV. Provider business mailing address

19 N 5TH ST # 201
FORT SMITH AR
72901-2137
US

V. Phone/Fax

Practice location:
  • Phone: 918-960-7852
  • Fax: 539-664-5738
Mailing address:
  • Phone: 918-344-7262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number06981
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP2408005
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: