Provider Demographics
NPI:1477882058
Name:REBEL BUERSMEYER, LLC
Entity Type:Organization
Organization Name:REBEL BUERSMEYER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:REBEL
Authorized Official - Middle Name:COURTNEY
Authorized Official - Last Name:BUERSMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, LADC
Authorized Official - Phone:405-242-5305
Mailing Address - Street 1:PO BOX 20776
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73156-0776
Mailing Address - Country:US
Mailing Address - Phone:405-242-5305
Mailing Address - Fax:405-242-5345
Practice Address - Street 1:2932 NW 122ND ST
Practice Address - Street 2:SUITE 20
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-1957
Practice Address - Country:US
Practice Address - Phone:405-242-5305
Practice Address - Fax:405-242-5345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK891251S00000X
OK544251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health