Provider Demographics
NPI:1285807925
Name:BROTHERTON, DEVAN T (MS LPC)
Entity type:Individual
Prefix:
First Name:DEVAN
Middle Name:T
Last Name:BROTHERTON
Suffix:
Gender:M
Credentials:MS LPC
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Other - Credentials:
Mailing Address - Street 1:1011 HONOR HEIGHTS DR
Mailing Address - Street 2:BEHAVIORAL MEDICINE 116
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-1318
Mailing Address - Country:US
Mailing Address - Phone:918-577-3655
Mailing Address - Fax:918-577-3701
Practice Address - Street 1:1011 HONOR HEIGHTS DR
Practice Address - Street 2:BEHAVIORAL MEDICINE 116
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-1318
Practice Address - Country:US
Practice Address - Phone:918-577-3655
Practice Address - Fax:918-577-3701
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2008-10-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK2166101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional