Provider Demographics
NPI:1790005593
Name:BROWN, GREGORY S (LPC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:S
Last Name:BROWN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 NE 28TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105-2804
Mailing Address - Country:US
Mailing Address - Phone:405-231-3150
Mailing Address - Fax:405-231-3157
Practice Address - Street 1:312 NE 28TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-2804
Practice Address - Country:US
Practice Address - Phone:405-231-3150
Practice Address - Fax:405-231-3157
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2344101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health