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1861580375
BRENT MATTHEW BLACK
OKMULGEE, OK
NPI
1861580375
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YP2500X Counselor, Professional
(Licence: OK 3251)
Enumeration Date
2006-10-10
Last Update Date
2007-07-08
Business Address
Mr. BRENT MATTHEW BLACK LPC
114 N GRAND AVE SUITE 419
OKMULGEE, OK 74447-4013
Phone number: 918-756-9411
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Mailing Address
Mr. BRENT MATTHEW BLACK LPC
4105 W ELGIN ST
BROKEN ARROW, OK 74012-8621
Phone number: 918-806-1423
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