Provider Demographics
NPI:1588342257
Name:OLDENBURG, BRANTLEY RUDENE (LMFT-A)
Entity type:Individual
Prefix:
First Name:BRANTLEY
Middle Name:RUDENE
Last Name:OLDENBURG
Suffix:
Gender:F
Credentials:LMFT-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4454 SUZANNE CIR
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-2240
Mailing Address - Country:US
Mailing Address - Phone:251-487-9049
Mailing Address - Fax:
Practice Address - Street 1:1 CHASE CORPORATE CENTER DR.
Practice Address - Street 2:SUITE 400
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35244
Practice Address - Country:US
Practice Address - Phone:205-905-8497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALA318106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist