Provider Demographics
NPI:1386146660
Name:WHITE, BREANNA (MS, LPC)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 N ELM AVE APT 243
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-1397
Mailing Address - Country:US
Mailing Address - Phone:918-231-0026
Mailing Address - Fax:
Practice Address - Street 1:8596 E 101ST ST STE D
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-7037
Practice Address - Country:US
Practice Address - Phone:918-231-0026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-02
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7446101YP2500X
OK101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselor