Provider Demographics
NPI:1689010191
Name:MAPLES, BRANDI RENAE
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:RENAE
Last Name:MAPLES
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 1:110 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-2405
Mailing Address - Country:US
Mailing Address - Phone:918-519-9490
Mailing Address - Fax:
Practice Address - Street 1:110 W 5TH ST
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-2405
Practice Address - Country:US
Practice Address - Phone:918-519-9490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-13
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker