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Individual

MS. SUSAN MARIE BREDEMEYER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LPC

Contact information

Practice address
6216 S LEWIS AVE STE 102, TULSA, OK 74136-1075
(539) 286-3955
Mailing address
PO BOX 700814, TULSA, OK 74170-0814
(918) 813-5255

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
10216
OK
101YP2500X
Professional Counselor
Primary
10216
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200287120A
OK
Enumeration date
05/02/2013
Last updated
09/24/2021
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