Provider Demographics
NPI:1760701429
Name:CUNNINGHAM, BRENDA ALICE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:ALICE
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:CHOUTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74337
Mailing Address - Country:US
Mailing Address - Phone:918-697-3822
Mailing Address - Fax:
Practice Address - Street 1:120 W. MAIN STREET
Practice Address - Street 2:
Practice Address - City:CHOUTEAU
Practice Address - State:OK
Practice Address - Zip Code:74337
Practice Address - Country:US
Practice Address - Phone:918-697-3822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-20
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK41391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical