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General NPI Number Information
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NPI Number | 1548609001
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Entity Type | Individual
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Provider Name | WANDA FAYE BRANTON LADC/MH
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Gender | Female
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Dates
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Enumeration Date | 06/18/2013
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Last Update Date | 05/28/2020
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Provider Practice Location Address
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Address Line | 8012 NW 7TH PL APT 330
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City | OKLAHOMA CITY
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State | OK
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Zip | 73127-4871
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Country | US
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Telephone | 405-410-4467
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Fax |
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Provider Business Mailing Address
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Address Line | 4913 W RENO AVE
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City | OKLAHOMA CITY
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State | OK
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Zip | 73127-6339
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Country | US
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Telephone | 405-948-4900
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Fax | 405-948-4933
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225C00000X
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Taxonomy Name | Rehabilitation Counselor
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License Number |
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License Number State |
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