Provider Demographics
NPI:1760706030
Name:RICKETTS, BRANDI JO
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:JO
Last Name:RICKETTS
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 1:11417 MARBELLA DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73173-8155
Mailing Address - Country:US
Mailing Address - Phone:405-202-3158
Mailing Address - Fax:405-261-2300
Practice Address - Street 1:11417 MARBELLA DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73173-8155
Practice Address - Country:US
Practice Address - Phone:405-202-3158
Practice Address - Fax:405-261-2300
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-16
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor