=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871711242
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BARBARA MOSS BRAMBLE LCSW, LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2007
-----------------------------------------------------
Last Update Date | 06/17/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2121 S COLUMBIA AVE SUITE 410
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74114-3505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-749-9897
-----------------------------------------------------
Fax | 918-749-9962
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2121 S COLUMBIA AVE SUITE 410
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74114-3505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-749-9897
-----------------------------------------------------
Fax | 918-749-9962
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 235
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 257
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------