Provider Demographics
NPI:1457688012
Name:BUNDRICK, ROBERT DWAIN (LPC (CANDIDATE))
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:DWAIN
Last Name:BUNDRICK
Suffix:
Gender:M
Credentials:LPC (CANDIDATE)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 CHAUTAUQUA AVE
Mailing Address - Street 2:CONDO 213
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-7734
Mailing Address - Country:US
Mailing Address - Phone:405-201-0337
Mailing Address - Fax:
Practice Address - Street 1:1922 N EASTERN AVE
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-5605
Practice Address - Country:US
Practice Address - Phone:405-735-5263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional