Individual
DERON BROWN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1322 W 9TH ST, ANTLERS, OK 74523-9308
(580) 579-3450
Mailing address
1322 W MAIN ST, ANTLERS, OK 74523-2016
(580) 298-5062
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200626640
—
OK
Enumeration date
06/23/2015
Last updated
06/16/2018
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