Healthcare Provider Details

I. General information

NPI: 1275997280
Provider Name (Legal Business Name): BREAWNA HEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2016
Last Update Date: 04/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 WALKING SKY RD
EDMOND OK
73013-6847
US

IV. Provider business mailing address

3505 WALKING SKY RD
EDMOND OK
73013-6847
US

V. Phone/Fax

Practice location:
  • Phone: 405-401-6167
  • Fax:
Mailing address:
  • Phone: 405-401-6167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberH082845218
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: