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NPI Profile for BRENT M BLACK in OKMULGEE, OK.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Professional |
101YP2500X |
| NPI Number | 1861580375 |
|
| Status | Active | |
| Credentials | LPC (Licensed Professional Counselor) | |
| Entity | Individual | |
| Enumeration date | 10/10/2006 | |
| Last updated | 07/08/2007 - About 19 years ago | |
| Sole proprietor 1 | Yes | |
| Identifiers |
|
|
| Hospital affiliation(s) | Not Available |
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BRENT M BLACK
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BRENT M BLACK, LPC