Healthcare Provider Details

I. General information

NPI: 1295042612
Provider Name (Legal Business Name): BRANDY NICHOLE PEOPLES LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2010
Last Update Date: 05/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9265 MOCKINGBIRD LN
TALALA OK
74080-9588
US

IV. Provider business mailing address

9265 MOCKINGBIRD LN
TALALA OK
74080-9588
US

V. Phone/Fax

Practice location:
  • Phone: 918-695-2059
  • Fax:
Mailing address:
  • Phone: 918-695-2059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: