Provider Demographics
NPI:1982125787
Name:BLACK, BRITTANY M (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:M
Last Name:BLACK
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 PERIMETER CENTER DR STE 245
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-2322
Mailing Address - Country:US
Mailing Address - Phone:405-293-2956
Mailing Address - Fax:
Practice Address - Street 1:4200 PERIMETER CENTER DR STE 245
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2322
Practice Address - Country:US
Practice Address - Phone:405-808-3541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-30
Last Update Date:2020-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1345106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty