Provider Demographics
NPI:1982127395
Name:BEAVERS, BROOK (MED, LPC)
Entity Type:Individual
Prefix:
First Name:BROOK
Middle Name:
Last Name:BEAVERS
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 722041
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-8548
Mailing Address - Country:US
Mailing Address - Phone:405-831-4125
Mailing Address - Fax:
Practice Address - Street 1:4045 NW 64TH ST STE 520
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-8608
Practice Address - Country:US
Practice Address - Phone:405-842-4911
Practice Address - Fax:405-842-5807
Is Sole Proprietor?:No
Enumeration Date:2017-07-18
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2115101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional