Provider Demographics
NPI:1568800027
Name:THORNTON, BRANDY DEANN (MHR)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:DEANN
Last Name:THORNTON
Suffix:
Gender:F
Credentials:MHR
Other - Prefix:
Other - First Name:BRANDY
Other - Middle Name:DEANN
Other - Last Name:WOOD-RICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1728 SW 33RD ST
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-2925
Mailing Address - Country:US
Mailing Address - Phone:405-979-0064
Mailing Address - Fax:
Practice Address - Street 1:1728 SW 33RD ST
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-2925
Practice Address - Country:US
Practice Address - Phone:405-979-0064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-06
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional