Individual
MRS. BRANDI D DETHEROW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW PROVISIONAL
Contact information
Practice address
15 E DEWEY AVE, SAPULPA, OK 74066-4201
(918) 227-2016
(918) 227-1125
Mailing address
832 W COMMERCIAL ST., BROKEN ARROW, OK 74012
(918) 607-3444
(918) 227-1125
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
NONE
OK
Other
Enumeration date
04/23/2007
Last updated
07/08/2007
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