Provider Demographics
NPI:1760597272
Name:MAYNOR, BRIAN G (MED, LPC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:G
Last Name:MAYNOR
Suffix:
Gender:M
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E. MAIN
Mailing Address - Street 2:RESOURCE MANAGEMENT
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820
Mailing Address - Country:US
Mailing Address - Phone:580-436-7211
Mailing Address - Fax:580-272-5757
Practice Address - Street 1:1726 N. GREEN AVE OUTPATIENT SERVICES- PURCELL
Practice Address - Street 2:STRONG FAMILY DEVELOPMENT
Practice Address - City:PURCELL
Practice Address - State:OK
Practice Address - Zip Code:73080
Practice Address - Country:US
Practice Address - Phone:405-767-8940
Practice Address - Fax:405-767-8949
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3751101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional