Provider Demographics
NPI:1013193317
Name:BRAZIEL, MARY MARGARET (BA)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:MARGARET
Last Name:BRAZIEL
Suffix:
Gender:F
Credentials:BA
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Mailing Address - Street 1:2 WICKERSHAM ST
Mailing Address - Street 2:
Mailing Address - City:MANGUM
Mailing Address - State:OK
Mailing Address - Zip Code:73554-9117
Mailing Address - Country:US
Mailing Address - Phone:580-782-3337
Mailing Address - Fax:580-782-3338
Practice Address - Street 1:2 WICKERSHAM ST
Practice Address - Street 2:
Practice Address - City:MANGUM
Practice Address - State:OK
Practice Address - Zip Code:73554-9117
Practice Address - Country:US
Practice Address - Phone:580-782-3337
Practice Address - Fax:580-782-3338
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)