Healthcare Provider Details

I. General information

NPI: 1326304130
Provider Name (Legal Business Name): JESSICA MAURINE BREWER MS, LPC CANDIDATE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2012
Last Update Date: 04/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5272 S LEWIS AVE 250
TULSA OK
74105-6544
US

IV. Provider business mailing address

16702 S HARVARD AVE
BIXBY OK
74008-5147
US

V. Phone/Fax

Practice location:
  • Phone: 918-524-3300
  • Fax: 918-524-3302
Mailing address:
  • Phone: 918-260-9703
  • Fax: 918-524-3302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: