MEDICARE: LARRY D. 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1811426182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARRY D. BROWN

Provider Business Mailing Address
First Line	:	4717 NW 70TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73132-6839
Country	:	US
Telephone Number	:	14057735293
Fax Number	:

Provider Business Practice Location Address
First Line	:	4717 NW 70TH ST.
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73132
Country	:	US
Telephone Number	:	14057735293
Fax Number	:

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

Provider Enumeration Date	:	06/08/2017
Last Update Date	:	06/08/2017

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