Provider Demographics
NPI:1548517691
Name:HOWARD, BRIAN DAVID
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:DAVID
Last Name:HOWARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11804 GWENDOLYN LN
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73131-4402
Mailing Address - Country:US
Mailing Address - Phone:405-205-0505
Mailing Address - Fax:
Practice Address - Street 1:11804 GWENDOLYN LN
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73131-4402
Practice Address - Country:US
Practice Address - Phone:405-205-0505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst