Provider Demographics
NPI:1831314442
Name:GILL, BRENDA DEE (MS, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:DEE
Last Name:GILL
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:MISS
Other - First Name:B
Other - Middle Name:DEE
Other - Last Name:C
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:408 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:PERKINS
Mailing Address - State:OK
Mailing Address - Zip Code:74059-4103
Mailing Address - Country:US
Mailing Address - Phone:405-880-0674
Mailing Address - Fax:405-624-2408
Practice Address - Street 1:115 E 4TH AVE
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-3527
Practice Address - Country:US
Practice Address - Phone:405-377-2344
Practice Address - Fax:405-624-2408
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK752106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist