Provider Demographics
NPI:1326304130
Name:BREWER, JESSICA MAURINE (MS, LPC CANDIDATE)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MAURINE
Last Name:BREWER
Suffix:
Gender:F
Credentials:MS, LPC CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:16702 S HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-5147
Mailing Address - Country:US
Mailing Address - Phone:918-260-9703
Mailing Address - Fax:918-524-3302
Practice Address - Street 1:5272 S LEWIS AVE
Practice Address - Street 2:250
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-6544
Practice Address - Country:US
Practice Address - Phone:918-524-3300
Practice Address - Fax:918-524-3302
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health