Provider Demographics
NPI:1588006688
Name:BRAKEFIELD, KATIE MAE (CMII & LPC UNDER SUP)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:MAE
Last Name:BRAKEFIELD
Suffix:
Gender:F
Credentials:CMII & LPC UNDER SUP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 SE 16TH TER
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:OK
Mailing Address - Zip Code:73065-6039
Mailing Address - Country:US
Mailing Address - Phone:405-250-7612
Mailing Address - Fax:
Practice Address - Street 1:1213 SE 16TH TER
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:OK
Practice Address - Zip Code:73065-6039
Practice Address - Country:US
Practice Address - Phone:405-250-7612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-18
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor