Provider Demographics
NPI:1275997280
Name:HEY, BREAWNA
Entity Type:Individual
Prefix:
First Name:BREAWNA
Middle Name:
Last Name:HEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 WALKING SKY RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-6847
Mailing Address - Country:US
Mailing Address - Phone:405-401-6167
Mailing Address - Fax:
Practice Address - Street 1:3505 WALKING SKY RD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-6847
Practice Address - Country:US
Practice Address - Phone:405-401-6167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKH082845218101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health