Provider Demographics
NPI:1477866945
Name:BEAUFORD, ZELLA MARIE (MS, LPC CANDIDATE)
Entity Type:Individual
Prefix:MRS
First Name:ZELLA
Middle Name:MARIE
Last Name:BEAUFORD
Suffix:
Gender:F
Credentials:MS, LPC CANDIDATE
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:
Other - Last Name:BEAUFORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LPC CANDIDATE
Mailing Address - Street 1:PO BOX 218
Mailing Address - Street 2:
Mailing Address - City:BOLEY
Mailing Address - State:OK
Mailing Address - Zip Code:74829-0218
Mailing Address - Country:US
Mailing Address - Phone:918-667-3367
Mailing Address - Fax:918-667-3387
Practice Address - Street 1:RR 1
Practice Address - Street 2:
Practice Address - City:BOLEY
Practice Address - State:OK
Practice Address - Zip Code:74829
Practice Address - Country:US
Practice Address - Phone:918-667-3367
Practice Address - Fax:918-667-3387
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LPC CANDIDATE101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100685660DMedicaid
OK100685660AMedicaid