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General NPI Number Information
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NPI Number | 1245447572
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Entity Type | Individual
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Provider Name | MATTHEW WILLIAM BROSI PH.D.
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Gender | Male
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | CENTER FOR FAMILY SERVICES 101 HUMAN ENVIRONMENTAL SCIENCES WEST
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City | STILLWATER
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State | OK
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Zip | 74078-6122
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Country | US
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Telephone | 405-744-5058
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Fax |
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Provider Business Mailing Address
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Address Line | 6719 S WESTERN RD
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City | STILLWATER
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State | OK
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Zip | 74074-2413
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Country | US
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Telephone | 405-707-8069
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 4101006350
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License Number State | MI
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