Individual
MR. BRANDON JEFFERY VANDIVER I
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4400 N LINCOLN BLVD, OKLAHOMA CITY, OK 73105-5104
(405) 424-7711
(405) 425-0343
Mailing address
4400 N LINCOLN BLVD, OKLAHOMA CITY, OK 73105-5104
(405) 651-5684
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
02/16/2015
Last updated
02/16/2015
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