Provider Demographics
NPI:1336578897
Name:HUNTER, BRENNAN
Entity Type:Individual
Prefix:
First Name:BRENNAN
Middle Name:
Last Name:HUNTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1319 E HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE
Mailing Address - State:OK
Mailing Address - Zip Code:73044-5413
Mailing Address - Country:US
Mailing Address - Phone:318-450-7875
Mailing Address - Fax:
Practice Address - Street 1:1319 E HARRISON AVE
Practice Address - Street 2:
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044-5413
Practice Address - Country:US
Practice Address - Phone:318-450-7875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator