Provider Demographics
NPI:1962869982
Name:RECOVERY SOLUTIONS INTENSIVE THERAPY OPTION
Entity type:Organization
Organization Name:RECOVERY SOLUTIONS INTENSIVE THERAPY OPTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BUERSMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-242-5305
Mailing Address - Street 1:10400 VINEYARD BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-3829
Mailing Address - Country:US
Mailing Address - Phone:405-242-5305
Mailing Address - Fax:405-242-5345
Practice Address - Street 1:10400 VINEYARD BLVD
Practice Address - Street 2:STE A
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-3829
Practice Address - Country:US
Practice Address - Phone:405-242-5305
Practice Address - Fax:405-242-5345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK891106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty