Provider Demographics
NPI:1710354592
Name:TRUEBLOOD, BRANDON MICHAEL (MA)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:MICHAEL
Last Name:TRUEBLOOD
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 N MACARTHUR BLVD
Mailing Address - Street 2:SUITE#219
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73127-2617
Mailing Address - Country:US
Mailing Address - Phone:580-512-0047
Mailing Address - Fax:
Practice Address - Street 1:1900 N MACARTHUR BLVD
Practice Address - Street 2:SUITE#219
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73127-2617
Practice Address - Country:US
Practice Address - Phone:580-512-0047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-27
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17161101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral