Provider Demographics
NPI:1316179120
Name:BREWER, CARI J
Entity Type:Individual
Prefix:
First Name:CARI
Middle Name:J
Last Name:BREWER
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 1:1004 E HIGHWAY 54
Mailing Address - Street 2:
Mailing Address - City:GUYMON
Mailing Address - State:OK
Mailing Address - Zip Code:73942-4549
Mailing Address - Country:US
Mailing Address - Phone:580-338-7259
Mailing Address - Fax:580-338-2521
Practice Address - Street 1:1004 E HIGHWAY 54
Practice Address - Street 2:
Practice Address - City:GUYMON
Practice Address - State:OK
Practice Address - Zip Code:73942-4549
Practice Address - Country:US
Practice Address - Phone:580-338-7259
Practice Address - Fax:580-338-2521
Is Sole Proprietor?:No
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK$$$$$$$$$OtherBEHAVIORAL HEALTH AND SOCIAL SERVICE PROVIDERS