Organization
BRENDA SUE MATHIS
Active
Other names
Brenda Sue Mathis
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BRENDA SUE MATHIS MAMFT (OWNER)
(918) 698-7171
Entity
Organization
Contact information
Practice address
4034 W ROANOKE PL, BROKEN ARROW, OK 74011-1327
(918) 698-7171
Mailing address
4034 W ROANOKE PL, BROKEN ARROW, OK 74011-1327
(918) 698-7171
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
OK
323P00000X
Psychiatric Residential Treatment Facility
—
OK
324500000X
Substance Abuse Rehabilitation Facility
—
OK
Other
Enumeration date
09/28/2009
Last updated
09/28/2009
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