Individual
JONATHAN BRODRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
405 E EXCELSIOR AVE, VINITA, OK 74301-4226
(918) 256-6476
(918) 256-3628
Mailing address
1109 6TH NW, MIAMI, OK 74354
(918) 533-8770
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
04/10/2009
Last updated
09/07/2011
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