Provider Demographics
NPI:1003172032
Name:SARGENT, BRANDY NICHOLLE
Entity Type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:NICHOLLE
Last Name:SARGENT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 DOVE HOLW
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-4121
Mailing Address - Country:US
Mailing Address - Phone:405-610-2153
Mailing Address - Fax:
Practice Address - Street 1:500 N MERIDIAN AVE
Practice Address - Street 2:#304
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-5700
Practice Address - Country:US
Practice Address - Phone:405-601-7367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health