Provider Demographics
NPI:1497527956
Name:FSC KIDS, LLC
Entity Type:Organization
Organization Name:FSC KIDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BUERSMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:405-242-5305
Mailing Address - Street 1:10400 VINEYARD BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-3830
Mailing Address - Country:US
Mailing Address - Phone:405-242-5305
Mailing Address - Fax:405-242-5305
Practice Address - Street 1:10400 VINEYARD BLVD STE C
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-3830
Practice Address - Country:US
Practice Address - Phone:405-242-5305
Practice Address - Fax:405-242-5305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty