Provider Demographics
NPI:1851723506
Name:BOSS, DEBRA LEE (M ED LPC)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:LEE
Last Name:BOSS
Suffix:
Gender:F
Credentials:M ED LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4386 BAKER RD
Mailing Address - Street 2:
Mailing Address - City:ROFF
Mailing Address - State:OK
Mailing Address - Zip Code:74865-9503
Mailing Address - Country:US
Mailing Address - Phone:580-713-3571
Mailing Address - Fax:580-456-7820
Practice Address - Street 1:4386 BAKER RD
Practice Address - Street 2:
Practice Address - City:ROFF
Practice Address - State:OK
Practice Address - Zip Code:74865-9503
Practice Address - Country:US
Practice Address - Phone:580-713-3571
Practice Address - Fax:580-456-7820
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-05
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK226270103TS0200X
OK5833101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool