Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | OK | |
N | 101YM0800X | Mental Health Counselor | OK |
NPI | 1003038456 |
---|---|
Provider Name | Mr. Brian Eugene Abraham |
First Address | Tulsa, OK 74145-5751 |
Second Address | Tulsa, OK 74145-5751 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 08/07/2007 |