Provider Demographics
NPI:1336443910
Name:BROWN, BRUCE KIRKWOOD JR
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:KIRKWOOD
Last Name:BROWN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 NW 40TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-7043
Mailing Address - Country:US
Mailing Address - Phone:405-816-3335
Mailing Address - Fax:405-728-3353
Practice Address - Street 1:605 NW 40TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-7043
Practice Address - Country:US
Practice Address - Phone:405-816-3335
Practice Address - Fax:405-728-3353
Is Sole Proprietor?:No
Enumeration Date:2010-12-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral