Provider Demographics
NPI:1699716456
Name:BROWN, KANDRA JOY (LPC)
Entity type:Individual
Prefix:
First Name:KANDRA
Middle Name:JOY
Last Name:BROWN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KANDRA
Other - Middle Name:J
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:471688 HWY 51
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74960
Mailing Address - Country:US
Mailing Address - Phone:918-696-8830
Mailing Address - Fax:918-696-8803
Practice Address - Street 1:471688 HIGHWAY 51
Practice Address - Street 2:
Practice Address - City:STILWELL
Practice Address - State:OK
Practice Address - Zip Code:74960-4490
Practice Address - Country:US
Practice Address - Phone:918-696-8830
Practice Address - Fax:918-696-8803
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA9809040101YM0800X
ARP0701004101YM0800X
OK5391101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health