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General NPI Number Information
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NPI Number | 1740509504
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Entity Type | Individual
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Provider Name | PAULA ANN BONEBRAKE MS
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Gender | Female
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Dates
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Enumeration Date | 05/19/2010
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Last Update Date | 01/06/2020
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Provider Practice Location Address
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Address Line | 12801 E 85TH ST N STE 101
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City | OWASSO
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State | OK
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Zip | 74055-2259
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Country | US
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Telephone | 918-637-8373
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Fax | 918-856-3671
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Provider Business Mailing Address
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Address Line | 12312 E. 79TH CT. N.
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City | OWASSO
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State | OK
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Zip | 74055
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Country | US
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Telephone | 918-637-8373
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Fax | 918-856-3671
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1502
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License Number State | OK
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