Healthcare Provider Details

I. General information

NPI: 1891058905
Provider Name (Legal Business Name): STEVEN MICHAEL HARDEBECK II M.A., LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2012
Last Update Date: 06/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5831 E 78TH ST
TULSA OK
74136-8421
US

IV. Provider business mailing address

5831 E 78TH ST
TULSA OK
74136-8421
US

V. Phone/Fax

Practice location:
  • Phone: 405-513-4998
  • Fax:
Mailing address:
  • Phone: 405-513-4998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4692
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: