Provider Demographics
NPI:1457688277
Name:BROWN, AMY MARIE (MHR, LPC)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MARIE
Last Name:BROWN
Suffix:
Gender:F
Credentials:MHR, LPC
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:MARIE
Other - Last Name:JEFFERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MHR, LPC
Mailing Address - Street 1:124 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-3912
Mailing Address - Country:US
Mailing Address - Phone:918-697-9345
Mailing Address - Fax:
Practice Address - Street 1:124 N 1ST ST
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-3912
Practice Address - Country:US
Practice Address - Phone:918-697-9345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-16
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5244101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional