Provider Demographics
NPI:1568764702
Name:EARL, BRYTTANI (BA, BHRS, CMII)
Entity Type:Individual
Prefix:
First Name:BRYTTANI
Middle Name:
Last Name:EARL
Suffix:
Gender:F
Credentials:BA, BHRS, CMII
Other - Prefix:
Other - First Name:BRYTTANI
Other - Middle Name:
Other - Last Name:PROBST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5021 W CHEROKEE AVE
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-4613
Mailing Address - Country:US
Mailing Address - Phone:580-747-8816
Mailing Address - Fax:
Practice Address - Street 1:605 W OXFORD AVE
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-1208
Practice Address - Country:US
Practice Address - Phone:580-233-7220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-19
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst