Provider Demographics
NPI:1083632004
Name:BAUSE, BRENDA S (LPC)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:S
Last Name:BAUSE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 722
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74821-0722
Mailing Address - Country:US
Mailing Address - Phone:405-210-1110
Mailing Address - Fax:
Practice Address - Street 1:27B SOUTH WEST
Practice Address - Street 2:SUITE 100 & 200
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401
Practice Address - Country:US
Practice Address - Phone:918-712-0859
Practice Address - Fax:918-388-6456
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2337101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health