Provider Demographics
NPI:1306525894
Name:BUFFALO, TERESA L (LMSW U/S)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:L
Last Name:BUFFALO
Suffix:
Gender:F
Credentials:LMSW U/S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58150 E 66 RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74354-6509
Mailing Address - Country:US
Mailing Address - Phone:918-542-1786
Mailing Address - Fax:
Practice Address - Street 1:58150 E 66 RD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-6509
Practice Address - Country:US
Practice Address - Phone:918-542-1786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-13
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20386-P1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical