Provider Demographics
NPI:1518170935
Name:BROWN, TRENDOLYN
Entity Type:Individual
Prefix:MRS
First Name:TRENDOLYN
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2914 EPPERLY DR
Mailing Address - Street 2:
Mailing Address - City:DEL CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73115-3322
Mailing Address - Country:US
Mailing Address - Phone:405-604-9790
Mailing Address - Fax:405-702-7668
Practice Address - Street 1:2914 EPPERLY DR
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-3322
Practice Address - Country:US
Practice Address - Phone:405-604-9790
Practice Address - Fax:405-702-7668
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)