Healthcare Provider Details

I. General information

NPI: 1396553806
Provider Name (Legal Business Name): BREANNA HURD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2024
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 NE 13TH ST
OKLAHOMA CITY OK
73117-1039
US

IV. Provider business mailing address

100 NE 4TH ST APT 2104
OKLAHOMA CITY OK
73104-2007
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-5170
  • Fax:
Mailing address:
  • Phone: 405-464-5115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCCANDIDATE12290
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: