Provider Demographics
NPI:1548677032
Name:AJ BRANDON COUNSELING SERVICES PLLC
Entity type:Organization
Organization Name:AJ BRANDON COUNSELING SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:MS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRANDON
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:405-204-6424
Mailing Address - Street 1:10400 VINEYARD BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-3829
Mailing Address - Country:US
Mailing Address - Phone:405-204-6424
Mailing Address - Fax:405-242-5345
Practice Address - Street 1:10400 VINEYARD BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-3829
Practice Address - Country:US
Practice Address - Phone:405-204-6424
Practice Address - Fax:405-242-5345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5385101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty