Provider Demographics
NPI:1740865112
Name:BUSS, CHANDRA VYNON (MS LPC-C)
Entity type:Individual
Prefix:
First Name:CHANDRA
Middle Name:VYNON
Last Name:BUSS
Suffix:
Gender:F
Credentials:MS LPC-C
Other - Prefix:
Other - First Name:CHANDRA
Other - Middle Name:VYNON
Other - Last Name:COLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7161 S BRADEN AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-6302
Mailing Address - Country:US
Mailing Address - Phone:918-319-2935
Mailing Address - Fax:
Practice Address - Street 1:104 E CARL ALBERT PKWY
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5092
Practice Address - Country:US
Practice Address - Phone:918-423-0220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health