Provider Demographics
NPI:1669790366
Name:CALDWELL, BRIAN JAMES
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:JAMES
Last Name:CALDWELL
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 1:301 E MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WILBURTON
Mailing Address - State:OK
Mailing Address - Zip Code:74578-4415
Mailing Address - Country:US
Mailing Address - Phone:918-465-0300
Mailing Address - Fax:918-465-0300
Practice Address - Street 1:301 E MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:WILBURTON
Practice Address - State:OK
Practice Address - Zip Code:74578-4415
Practice Address - Country:US
Practice Address - Phone:918-465-0300
Practice Address - Fax:918-465-0300
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-06
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor