Provider Demographics
NPI:1124666581
Name:BROWN, OTI-LISA DEANNA (LMSW)
Entity type:Individual
Prefix:MS
First Name:OTI-LISA
Middle Name:DEANNA
Last Name:BROWN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:OTILISA
Other - Middle Name:DEANNA
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:2442 MOHAWK BLVD
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74110-1519
Mailing Address - Country:US
Mailing Address - Phone:918-430-0975
Mailing Address - Fax:918-403-6317
Practice Address - Street 1:1919 S WHEELING AVE STE 404
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5633
Practice Address - Country:US
Practice Address - Phone:918-748-7640
Practice Address - Fax:918-403-6317
Is Sole Proprietor?:No
Enumeration Date:2019-12-17
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK374J00000X
OK2187104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No374J00000XNursing Service Related ProvidersDoula