Provider Demographics
NPI:1588793780
Name:CHADWICK-LIECHTI, BRENDA GAYLE (MSC, LPC, CM-A)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:GAYLE
Last Name:CHADWICK-LIECHTI
Suffix:
Gender:F
Credentials:MSC, LPC, CM-A
Other - Prefix:MRS
Other - First Name:BRENDA
Other - Middle Name:GAYLE
Other - Last Name:CHADWICK-LIECHTI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSC, LPC, CM-A
Mailing Address - Street 1:1101 E MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-4815
Mailing Address - Country:US
Mailing Address - Phone:918-426-7800
Mailing Address - Fax:918-426-5526
Practice Address - Street 1:2000 E LINCOLN RD
Practice Address - Street 2:
Practice Address - City:IDABEL
Practice Address - State:OK
Practice Address - Zip Code:74745-7353
Practice Address - Country:US
Practice Address - Phone:580-286-6639
Practice Address - Fax:580-286-5206
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health