Provider Demographics
NPI:1770798498
Name:MCBROOM, CHARLES DENNIS (MS,LADC)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:DENNIS
Last Name:MCBROOM
Suffix:
Gender:M
Credentials:MS,LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3607 HARVEY RD
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-6610
Mailing Address - Country:US
Mailing Address - Phone:918-333-7259
Mailing Address - Fax:
Practice Address - Street 1:622 SE FRANK PHILLIPS BLVD
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74003-3917
Practice Address - Country:US
Practice Address - Phone:918-336-4646
Practice Address - Fax:918-336-8710
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)