=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013880228
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PAULA BONEBRAKE, LPC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2025
-----------------------------------------------------
Last Update Date | 09/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12801 E 85TH ST N STE 101
-----------------------------------------------------
City | OWASSO
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74055-2259
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-637-8373
-----------------------------------------------------
Fax | 918-856-3671
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12801 E 85TH ST N STE 101
-----------------------------------------------------
City | OWASSO
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74055-2259
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-637-8373
-----------------------------------------------------
Fax | 918-856-3671
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED PROFESSIONAL COUNSELOR
-----------------------------------------------------
Name | MRS. PAULA ANN BONEBRAKE
-----------------------------------------------------
Credential | MS LPC
-----------------------------------------------------
Telephone | 918-637-8373
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------