Provider Demographics
NPI:1952651291
Name:BROWN, RACHEL LEAH
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:LEAH
Last Name:BROWN
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 1:20969 BIRCH AVE
Mailing Address - Street 2:
Mailing Address - City:HOWE
Mailing Address - State:OK
Mailing Address - Zip Code:74940-3249
Mailing Address - Country:US
Mailing Address - Phone:918-658-8269
Mailing Address - Fax:
Practice Address - Street 1:20969 BIRCH AVE
Practice Address - Street 2:
Practice Address - City:HOWE
Practice Address - State:OK
Practice Address - Zip Code:74940-3249
Practice Address - Country:US
Practice Address - Phone:918-658-8269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200226970AMedicaid