Provider Demographics
NPI:1043303225
Name:HEMSTREET, BRETT ELLIOTT (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:ELLIOTT
Last Name:HEMSTREET
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 N OAKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-2924
Mailing Address - Country:US
Mailing Address - Phone:580-234-5330
Mailing Address - Fax:580-234-8793
Practice Address - Street 1:1026 N OAKWOOD RD
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-2924
Practice Address - Country:US
Practice Address - Phone:580-234-5330
Practice Address - Fax:580-234-8793
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK899103T00000X
KS966103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist