Individual
MS. BRENDA JOYCE GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1123 E 1ST ST, OKMULGEE, OK 74447-3725
(918) 304-7071
Mailing address
1123 E.1ST STREET, OKMULGEE, OK 74447
(918) 304-7071
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1649519109
—
OK
Enumeration date
09/25/2014
Last updated
09/25/2014
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