Provider Demographics
NPI:1508396821
Name:TWYMAN BRACK, HAYLEY LAYNE (LPC-CANDIDATE)
Entity Type:Individual
Prefix:
First Name:HAYLEY
Middle Name:LAYNE
Last Name:TWYMAN BRACK
Suffix:
Gender:F
Credentials:LPC-CANDIDATE
Other - Prefix:
Other - First Name:HAYLEY
Other - Middle Name:LAYNE
Other - Last Name:TWYMAN BRACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HAYLEY LAYNE TWYMAN
Mailing Address - Street 1:201 N GRAND FORK DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-4753
Mailing Address - Country:US
Mailing Address - Phone:580-303-0370
Mailing Address - Fax:
Practice Address - Street 1:409 S FRETZ AVE STE C
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-5570
Practice Address - Country:US
Practice Address - Phone:580-303-0370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-19
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health