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NPI Code Detail

MEDICARE: MS. SUSAN MARIE BREDEMEYER LPC

MEDICARE: MS. SUSAN MARIE BREDEMEYER LPC
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
1101YM0800XMental Health Counselor10216OK
2101YP2500XProfessional Counselor10216OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1851736920
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SUSAN MARIE BREDEMEYER LPC
Provider Business Mailing Address
First Line : PO BOX 700814
Second Line :
City : TULSA
State : OK
Zip : 74170-0814
Country : US
Telephone Number : 918-813-5255
Fax Number :
Provider Business Practice Location Address
First Line : 6216 S LEWIS AVE STE 102
Second Line :
City : TULSA
State : OK
Zip : 74136-1075
Country : US
Telephone Number : 539-286-3955
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2013
Last Update Date : 09/24/2021

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