Healthcare Provider Details

I. General information

NPI: 1356436877
Provider Name (Legal Business Name): WILLIAM JAMES BUKER DMIN, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 03/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5215 E 71ST ST SUITE 1300
TULSA OK
74136-6341
US

IV. Provider business mailing address

9524 SOUTH MAPLEWOOD AVE.
TULSA OK
74137
US

V. Phone/Fax

Practice location:
  • Phone: 918-299-4357
  • Fax:
Mailing address:
  • Phone: 918-764-8381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1382
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: