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NPI Code Detail

MEDICARE: BRENDA KAYE LAWSON MS, LADC-MH

MEDICARE: BRENDA KAYE LAWSON MS, LADC-MH
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
1101YA0400XAddiction (Substance Use Disorder) Counselor
2101YA0400XAddiction (Substance Use Disorder) Counselor733OK

General Provider Information

NPI Number : 1609068501
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRENDA KAYE LAWSON MS, LADC-MH
Provider Business Mailing Address
First Line : 711 S MUSKOGEE AVE
Second Line :
City : TAHLEQUAH
State : OK
Zip : 74464-4717
Country : US
Telephone Number : 918-525-4625
Fax Number :
Provider Business Practice Location Address
First Line : 711 S MUSKOGEE AVE
Second Line :
City : TAHLEQUAH
State : OK
Zip : 74464-4717
Country : US
Telephone Number : 918-525-4625
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/14/2007
Last Update Date : 04/25/2024

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