Individual
MS. BRENDA JOYCE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BHRS
Contact information
Practice address
30 C STREET N. E., MIAMI, OK 74354-3361
(918) 540-1563
(918) 542-7778
Mailing address
30 C ST NE, MIAMI, OK 74354-6316
(918) 540-1563
(918) 542-7778
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100732380C
—
OK
Enumeration date
01/22/2010
Last updated
07/26/2010
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