MEDICARE: BRENT FERRIS 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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1770227753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRENT FERRIS LLC

Provider Business Mailing Address
First Line	:	12220 N MACARTHUR BLVD STE F9
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73162-1850
Country	:	US
Telephone Number	:	405-821-4929
Fax Number	:	405-242-3481

Provider Business Practice Location Address
First Line	:	12220 N MACARTHUR BLVD STE F9
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73162-1850
Country	:	US
Telephone Number	:	405-821-4929
Fax Number	:	405-242-3481

Authorized Official
Title or Position	:	THERAPIST
Name	:	MR. BRENT FERRIS
Credential	:	LMFT
Telephone Number	:	405-821-4929

Provider Enumeration Date	:	04/25/2022
Last Update Date	:	04/25/2022

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