Provider Demographics
NPI:1477765675
Name:BUERSMEYER, REBEL COURTNEY (LADC, LMFT)
Entity type:Individual
Prefix:
First Name:REBEL
Middle Name:COURTNEY
Last Name:BUERSMEYER
Suffix:
Gender:F
Credentials:LADC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:405-249-8734
Mailing Address - Fax:
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2009-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK544101YA0400X
OK891106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)