Provider Demographics
NPI:1043803943
Name:MAULDIN-LOOBY, BRIANA MARIE (MS,LPC)
Entity type:Individual
Prefix:
First Name:BRIANA
Middle Name:MARIE
Last Name:MAULDIN-LOOBY
Suffix:
Gender:F
Credentials:MS,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11132 ABBEYWOOD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-3207
Mailing Address - Country:US
Mailing Address - Phone:405-694-0553
Mailing Address - Fax:
Practice Address - Street 1:701 CEDAR LAKE BLVD STE 142
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-7817
Practice Address - Country:US
Practice Address - Phone:405-694-0553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-11
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10822101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional