Provider Demographics
NPI:1881984284
Name:CANNON, BRANDI NICOLE (MA:MFT US)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:NICOLE
Last Name:CANNON
Suffix:
Gender:F
Credentials:MA:MFT US
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8643 E 77TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-3710
Mailing Address - Country:US
Mailing Address - Phone:918-606-7242
Mailing Address - Fax:
Practice Address - Street 1:2448 E 81ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-4250
Practice Address - Country:US
Practice Address - Phone:918-606-7242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-19
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist