Individual
MR. BRENT MATTHEW BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
114 N GRAND AVE, SUITE 419, OKMULGEE, OK 74447-4013
(918) 756-9411
Mailing address
4105 W ELGIN ST, BROKEN ARROW, OK 74012-8621
(918) 806-1423
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
3251
OK
Other
Enumeration date
10/10/2006
Last updated
07/08/2007
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