Provider Demographics
NPI:1407400518
Name:OLSSON, REBECCA LEE BINGHAM
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LEE BINGHAM
Last Name:OLSSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 OAK CREEK DR
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-1645
Mailing Address - Country:US
Mailing Address - Phone:405-509-1715
Mailing Address - Fax:
Practice Address - Street 1:501 N WALKER AVE STE 140
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1233
Practice Address - Country:US
Practice Address - Phone:405-841-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-26
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20294-P104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker