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General NPI Number Information
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NPI Number | 1326304130
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Entity Type | Individual
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Provider Name | JESSICA MAURINE BREWER MS, LPC CANDIDATE
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Gender | Female
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Dates
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Enumeration Date | 04/05/2012
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Last Update Date | 04/05/2012
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Provider Practice Location Address
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Address Line | 5272 S LEWIS AVE 250
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City | TULSA
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State | OK
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Zip | 74105-6544
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Country | US
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Telephone | 918-524-3300
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Fax | 918-524-3302
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Provider Business Mailing Address
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Address Line | 16702 S HARVARD AVE
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City | BIXBY
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State | OK
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Zip | 74008-5147
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Country | US
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Telephone | 918-260-9703
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Fax | 918-524-3302
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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 |
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License Number State |
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