Provider Demographics
NPI:1629327325
Name:DEMERY, BRITTANY TYSHE'
Entity Type:Individual
Prefix:MS
First Name:BRITTANY
Middle Name:TYSHE'
Last Name:DEMERY
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 1:1608 NE 26TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73111-3203
Mailing Address - Country:US
Mailing Address - Phone:405-887-3842
Mailing Address - Fax:
Practice Address - Street 1:1608 NE 26TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73111-3203
Practice Address - Country:US
Practice Address - Phone:405-887-3842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKH082731241101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional