Healthcare Provider Details

I. General information

NPI: 1932833969
Provider Name (Legal Business Name): CHEYENNE BRANSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 08/16/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2617 GENERAL PERSHING BLVD
OKLAHOMA CITY OK
73107-6437
US

IV. Provider business mailing address

401 N 1ST ST
GUTHRIE OK
73044-3116
US

V. Phone/Fax

Practice location:
  • Phone: 405-858-2700
  • Fax:
Mailing address:
  • Phone: 405-209-4738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: