MEDICARE: BARUNDI NACHELLE LOLLES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1154672509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARUNDI NACHELLE LOLLES

Provider Business Mailing Address
First Line	:	3019 N BARTELL RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73121-6830
Country	:	US
Telephone Number	:	405-505-8798
Fax Number	:

Provider Business Practice Location Address
First Line	:	3019 N BARTELL RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73121-6830
Country	:	US
Telephone Number	:	405-505-8798
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2012
Last Update Date	:	09/25/2012

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Directions to “ BARUNDI NACHELLE LOLLES ” Practice Location

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