Provider Demographics
NPI:1013445824
Name:BROKAW, MONICA (MS, LMFT CAND)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:BROKAW
Suffix:
Gender:F
Credentials:MS, LMFT CAND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 NE 20TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73507-7406
Mailing Address - Country:US
Mailing Address - Phone:580-919-7948
Mailing Address - Fax:
Practice Address - Street 1:19 NE 20TH ST
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73507-7406
Practice Address - Country:US
Practice Address - Phone:580-919-7948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-24
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
OK101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty