Provider Demographics
NPI:1427200682
Name:STICE, BRYAN DENNIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:DENNIS
Last Name:STICE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 892948
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73189-2948
Mailing Address - Country:US
Mailing Address - Phone:405-343-5006
Mailing Address - Fax:405-292-1787
Practice Address - Street 1:3280 MARSHALL AVE
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-8022
Practice Address - Country:US
Practice Address - Phone:405-343-5006
Practice Address - Fax:405-292-1787
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1076103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist