Organization
SHANNON BRUEY PMHMP LLC
Active
Other names
Balanced Mental Health
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON BRUEY PMHMP (OWNER/PROVIDER)
(580) 984-1115
Entity
Organization
Contact information
Practice address
121 W MAPLE AVE, ENID, OK 73701-4027
(580) 984-1115
Mailing address
121 W MAPLE AVE, ENID, OK 73701-4027
(580) 984-1115
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12659854717
BLUE CROSS AND BLUE SHIELD OK
OK
Enumeration date
04/22/2021
Last updated
04/22/2021
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