Healthcare Provider Details

I. General information

NPI: 1124666581
Provider Name (Legal Business Name): OTI-LISA DEANNA BROWN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OTILISA DEANNA BROWN LMSW

II. Dates (important events)

Enumeration Date: 12/17/2019
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 S WHEELING AVE STE 404
TULSA OK
74104-5633
US

IV. Provider business mailing address

2442 MOHAWK BLVD
TULSA OK
74110-1519
US

V. Phone/Fax

Practice location:
  • Phone: 918-748-7640
  • Fax: 918-403-6317
Mailing address:
  • Phone: 918-430-0975
  • Fax: 918-403-6317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2187
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: