Provider Demographics
NPI:1821406620
Name:BRISTER, AUDRA JEAN (MA: HUMAN SERVICES,)
Entity Type:Individual
Prefix:MRS
First Name:AUDRA
Middle Name:JEAN
Last Name:BRISTER
Suffix:
Gender:F
Credentials:MA: HUMAN SERVICES,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7037 S BIRMINGHAM CT
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-4322
Mailing Address - Country:US
Mailing Address - Phone:361-727-5372
Mailing Address - Fax:
Practice Address - Street 1:7037 S BIRMINGHAM CT
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-4322
Practice Address - Country:US
Practice Address - Phone:361-727-5372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist