=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740865112
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHANDRA VYNON BUSS M.S. LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2021
-----------------------------------------------------
Last Update Date | 10/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10 E WASHINGTON AVE STE 106
-----------------------------------------------------
City | MCALESTER
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74501-4623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-423-0220
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 318 W WASHINGTON AVE
-----------------------------------------------------
City | MCALESTER
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74501-4449
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-423-0220
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------