Provider Demographics
NPI:1669698957
Name:UNDIEME, ROBYN LORRAINE (MA MFT)
Entity type:Individual
Prefix:MRS
First Name:ROBYN
Middle Name:LORRAINE
Last Name:UNDIEME
Suffix:
Gender:F
Credentials:MA MFT
Other - Prefix:MS
Other - First Name:ROBYN
Other - Middle Name:LORRAINE
Other - Last Name:BUREK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:650 S PEORIA
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-4429
Mailing Address - Country:US
Mailing Address - Phone:918-587-9471
Mailing Address - Fax:918-560-0137
Practice Address - Street 1:11740 E 21ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74129-1820
Practice Address - Country:US
Practice Address - Phone:918-437-0596
Practice Address - Fax:918-234-4554
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor