Provider Demographics
NPI:1447731278
Name:BRUGMANN, KASSANDRA (MA)
Entity type:Individual
Prefix:MS
First Name:KASSANDRA
Middle Name:
Last Name:BRUGMANN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:KASSIE
Other - Middle Name:R
Other - Last Name:BRUGMANN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6644 S VICTOR AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-2401
Mailing Address - Country:US
Mailing Address - Phone:940-733-8620
Mailing Address - Fax:
Practice Address - Street 1:24797 OK-66 #5
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74019
Practice Address - Country:US
Practice Address - Phone:918-342-2080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor