Healthcare Provider Details

I. General information

NPI: 1679271621
Provider Name (Legal Business Name): AMANDA BUENO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8931 S YALE AVE
TULSA OK
74137-3526
US

IV. Provider business mailing address

4971 S MADISON AVE
TULSA OK
74105-4617
US

V. Phone/Fax

Practice location:
  • Phone: 918-324-6120
  • Fax:
Mailing address:
  • Phone: 918-853-0958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12238
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: