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NPI Code Detail

MEDICARE: MRS. MONA GAY BRENNEMAN BS IN PSYCHOLOGY

MEDICARE: MRS. MONA GAY BRENNEMAN BS IN PSYCHOLOGY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor00815KS
2101YA0400XAddiction (Substance Use Disorder) Counselor1028OK
3101YP2500XProfessional Counselor03353KS
4101YP2500XProfessional Counselor05910OK

General Provider Information

NPI Number : 1669506416
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MONA GAY BRENNEMAN BS IN PSYCHOLOGY
Provider Business Mailing Address
First Line : 407 W SOUTH AVE
Second Line :
City : PONCA CITY
State : OK
Zip : 74601-6133
Country : US
Telephone Number : 580-749-5056
Fax Number : 580-215-5756
Provider Business Practice Location Address
First Line : 407 W SOUTH AVE
Second Line :
City : PONCA CITY
State : OK
Zip : 74601-6133
Country : US
Telephone Number : 580-749-5056
Fax Number : 580-215-5756
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/15/2007
Last Update Date : 08/05/2025

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