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General NPI Number Information
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NPI Number | 1831851203
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Entity Type | Organization
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Legal Business Name | SYCAMORE TREE COUNSELING PLLC SAMANTHA BUGOS SOLE MEMBER
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Dates
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Enumeration Date | 10/12/2021
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Last Update Date | 10/13/2021
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Provider Practice Location Address
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Address Line | 207 S CZECH HALL RD
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City | YUKON
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State | OK
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Zip | 73099-6851
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Country | US
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Telephone | 405-673-1270
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Fax |
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Provider Business Mailing Address
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Address Line | 207 S CZECH HALL RD
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City | YUKON
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State | OK
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Zip | 73099-6851
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Country | US
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Telephone | 405-673-1270
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SAMANTHA BUGOS
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Credential | LPC
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Telephone | 405-535-5224
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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 |
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License Number State |
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