MEDICARE: HEATHER BROTTON, LLC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1619514908
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEATHER BROTTON, LLC

Provider Business Mailing Address
First Line	:	3033 NW 63RD ST STE 160E
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-3612
Country	:	US
Telephone Number	:	405-658-6244
Fax Number	:

Provider Business Practice Location Address
First Line	:	3033 NW 63RD ST STE 160E
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-3612
Country	:	US
Telephone Number	:	405-658-6244
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	HEATHER DAWN BROTTON
Credential	:	LPC
Telephone Number	:	405-658-6244

Provider Enumeration Date	:	12/05/2019
Last Update Date	:	12/05/2019

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