Provider Demographics
NPI:1902154495
Name:BROWN-HERRON, RICHETTA RENEE
Entity Type:Individual
Prefix:MRS
First Name:RICHETTA
Middle Name:RENEE
Last Name:BROWN-HERRON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 NW 117TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-7803
Mailing Address - Country:US
Mailing Address - Phone:405-819-5044
Mailing Address - Fax:405-242-2724
Practice Address - Street 1:2109 NW 117TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-7803
Practice Address - Country:US
Practice Address - Phone:405-819-5044
Practice Address - Fax:405-842-2724
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst