Provider Demographics
NPI:1992746267
Name:BREWER, JANA M (LPC, LBP)
Entity type:Individual
Prefix:MRS
First Name:JANA
Middle Name:M
Last Name:BREWER
Suffix:
Gender:F
Credentials:LPC, LBP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5002 SW LEE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-8320
Mailing Address - Country:US
Mailing Address - Phone:580-531-4512
Mailing Address - Fax:580-531-4519
Practice Address - Street 1:5002 SW LEE BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-8320
Practice Address - Country:US
Practice Address - Phone:580-531-4512
Practice Address - Fax:580-531-4519
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK93101Y00000X
OK1942101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor