Provider Demographics
NPI:1013169291
Name:GRASS, BRIANE MICHELLE
Entity Type:Individual
Prefix:MRS
First Name:BRIANE
Middle Name:MICHELLE
Last Name:GRASS
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 1:5843 S 69TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-8221
Mailing Address - Country:US
Mailing Address - Phone:918-712-2976
Mailing Address - Fax:918-712-2976
Practice Address - Street 1:5843 S 69TH EAST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-8221
Practice Address - Country:US
Practice Address - Phone:918-712-2976
Practice Address - Fax:918-712-2976
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-19
Last Update Date:2008-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health