Individual
MR. BRANDON JOHN MAGGIA SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
705 W 13TH ST, ATOKA, OK 74525-3712
(580) 889-5555
Mailing address
PO BOX 1710, KINGSTON, OK 73439-1710
(580) 564-7374
(580) 564-7362
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100708380M
—
OK
Enumeration date
08/23/2017
Last updated
08/23/2017
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