Provider Demographics
NPI:1477899409
Name:BROWN, BRENDA LATRICE
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:LATRICE
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:LATRICE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5319 WILLOW CLIFF RD APT 140
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73122-6322
Mailing Address - Country:US
Mailing Address - Phone:405-782-0363
Mailing Address - Fax:
Practice Address - Street 1:5319 WILLOW CLIFF RD APT 140
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73122-6322
Practice Address - Country:US
Practice Address - Phone:405-782-0363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor