Healthcare Provider Details

I. General information

NPI: 1104956507
Provider Name (Legal Business Name): CINDY BRUMLEY MBS, LPC, LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 W CHOCTAW ST
BROKEN BOW OK
74728-4525
US

IV. Provider business mailing address

RR 2 BOX 890
BROKEN BOW OK
74728-8909
US

V. Phone/Fax

Practice location:
  • Phone: 580-584-2285
  • Fax: 580-584-2284
Mailing address:
  • Phone: 580-306-5842
  • Fax: 580-584-2284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3340
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number719
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number300507
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: