MEDICARE: MRS. TRENDOLYN BROWN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1518170935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TRENDOLYN BROWN

Provider Business Mailing Address
First Line	:	2914 EPPERLY DR
Second Line	:
City	:	DEL CITY
State	:	OK
Zip	:	73115-3322
Country	:	US
Telephone Number	:	405-604-9790
Fax Number	:	405-702-7668

Provider Business Practice Location Address
First Line	:	2914 EPPERLY DR
Second Line	:
City	:	DEL CITY
State	:	OK
Zip	:	73115-3322
Country	:	US
Telephone Number	:	405-604-9790
Fax Number	:	405-702-7668

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	07/27/2011

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