Provider Demographics
NPI:1972636512
Name:ESS, BRIAN C (PHD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:C
Last Name:ESS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1333
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74018-1333
Mailing Address - Country:US
Mailing Address - Phone:539-202-6480
Mailing Address - Fax:539-424-3025
Practice Address - Street 1:202 E 2ND AVE
Practice Address - Street 2:STE 105
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-3131
Practice Address - Country:US
Practice Address - Phone:539-202-6480
Practice Address - Fax:539-424-3025
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY-9235103TC1900X
OK1267103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling