Provider Demographics
NPI:1841437555
Name:BRIGHAM, TRACY L (LPC)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:L
Last Name:BRIGHAM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 PAWHUSKA AVE
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-7649
Mailing Address - Country:US
Mailing Address - Phone:580-402-5492
Mailing Address - Fax:
Practice Address - Street 1:1906 PAWHUSKA AVE
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-7649
Practice Address - Country:US
Practice Address - Phone:580-402-5492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2953101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional