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General NPI Number Information
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NPI Number | 1083632004
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Entity Type | Individual
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Provider Name | BRENDA S BAUSE LPC
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Gender | Female
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 27B SOUTH WEST SUITE 100 & 200
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City | ARDMORE
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State | OK
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Zip | 73401
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Country | US
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Telephone | 918-712-0859
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Fax | 918-388-6456
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Provider Business Mailing Address
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Address Line | PO BOX 722
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City | ADA
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State | OK
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Zip | 74821-0722
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Country | US
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Telephone | 405-210-1110
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2337
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License Number State | OK
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