Healthcare Provider Details

I. General information

NPI: 1487856803
Provider Name (Legal Business Name): BUEL LEON REEDER MBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7010 S YALE AVE STE 215
TULSA OK
74136-5743
US

IV. Provider business mailing address

6410 N ANTLER RIDGE RD
SAND SPRINGS OK
74063-6008
US

V. Phone/Fax

Practice location:
  • Phone: 918-492-2554
  • Fax: 918-494-9870
Mailing address:
  • Phone: 918-346-7299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLBP 0005
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: