Provider Demographics
NPI:1093036006
Name:THOMPSON, BRENDA K (MS, LPC, LMFT, NBCC)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:K
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MS, LPC, LMFT, NBCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 W 24TH AVE
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-2109
Mailing Address - Country:US
Mailing Address - Phone:405-377-7828
Mailing Address - Fax:
Practice Address - Street 1:2216 W 12TH AVE
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-5127
Practice Address - Country:US
Practice Address - Phone:405-533-4090
Practice Address - Fax:405-533-4089
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK82876 NCC101YM0800X
OK3001101YP2500X
OK543106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist