Provider Demographics
NPI:1114259173
Name:BURNS, BRETT (BHRS)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:BURNS
Suffix:
Gender:M
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 1815
Mailing Address - Street 2:
Mailing Address - City:COALGATE
Mailing Address - State:OK
Mailing Address - Zip Code:74538-9764
Mailing Address - Country:US
Mailing Address - Phone:918-695-6150
Mailing Address - Fax:
Practice Address - Street 1:1501 S VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:OK
Practice Address - Zip Code:74525-3233
Practice Address - Country:US
Practice Address - Phone:580-889-3799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker