Jessie Brown

Individual provider Active NPI Community/Behavioral Health Agency · Bethany, OK

NPI 1548630650 · NPPES record last updated Oct 1, 2015

Key facts

NPI
1548630650
Entity type
Individual (NPI type 1)
Primary specialty
Community/Behavioral Health Agency 251S00000X
Practice address
8204 NW 31St Ter
Bethany, OK 73008-4348
Phone
(580) 458-0920
NPI assigned
Oct 1, 2015
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Yes

Addresses

Primary practice location

8204 NW 31St Ter
Bethany, OK 73008-4348

Mailing address

8204 NW 31St Ter
Bethany, OK 73008-4348
Phone (580) 458-0920

Other providers in Bethany, OK

All providers in Bethany, OK · Community/Behavioral Health Agency in Oklahoma

Sources for this page

Verify at the official NPI Registry.