Provider Demographics
NPI:1073374294
Name:REYNOLDS, BRANDON (LMFT-CANDIDATE)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:LMFT-CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 JONA KAY TER
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-4003
Mailing Address - Country:US
Mailing Address - Phone:479-879-5470
Mailing Address - Fax:
Practice Address - Street 1:4200 PERIMETER CENTER DR STE 102
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2310
Practice Address - Country:US
Practice Address - Phone:405-795-7526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist