Provider Demographics
NPI:1811236961
Name:BREWSTER, RICHARD ARNOLD
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:ARNOLD
Last Name:BREWSTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 E RICKENBACKER DR
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-5637
Mailing Address - Country:US
Mailing Address - Phone:405-664-7693
Mailing Address - Fax:
Practice Address - Street 1:516 E RICKENBACKER DR
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-5637
Practice Address - Country:US
Practice Address - Phone:405-664-7693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-09
Last Update Date:2013-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral