Provider Demographics
NPI:1467783399
Name:WALTERS POLANSKY, BRENDA L (MED/LPC)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:L
Last Name:WALTERS POLANSKY
Suffix:
Gender:F
Credentials:MED/LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-5300
Mailing Address - Country:US
Mailing Address - Phone:918-421-8880
Mailing Address - Fax:918-421-8929
Practice Address - Street 1:106 S 3RD ST
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5300
Practice Address - Country:US
Practice Address - Phone:918-421-8880
Practice Address - Fax:918-421-8929
Is Sole Proprietor?:No
Enumeration Date:2010-01-15
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health