Provider Demographics
NPI:1245447572
Name:BROSI, MATTHEW WILLIAM (PHD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:WILLIAM
Last Name:BROSI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6719 S WESTERN RD
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-2413
Mailing Address - Country:US
Mailing Address - Phone:405-707-8069
Mailing Address - Fax:
Practice Address - Street 1:CENTER FOR FAMILY SERVICES
Practice Address - Street 2:101 HUMAN ENVIRONMENTAL SCIENCES WEST
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74078-6122
Practice Address - Country:US
Practice Address - Phone:405-744-5058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101006350106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist