Provider Demographics
NPI:1205223815
Name:KELLOGG, BRENDAN (BA)
Entity Type:Individual
Prefix:
First Name:BRENDAN
Middle Name:
Last Name:KELLOGG
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W. MAIN
Mailing Address - Street 2:
Mailing Address - City:FRANCIS
Mailing Address - State:OK
Mailing Address - Zip Code:74844
Mailing Address - Country:US
Mailing Address - Phone:405-695-0175
Mailing Address - Fax:
Practice Address - Street 1:600 W. MAIN STREET
Practice Address - Street 2:
Practice Address - City:FRANCIS
Practice Address - State:OK
Practice Address - Zip Code:74844
Practice Address - Country:US
Practice Address - Phone:405-695-0175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor