Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 1578690137 |
NPI | 1003249830 |
---|---|
Provider Name | Miss Tierra Bradden |
First Address | Oklahoma City, OK 73135-2321 |
Second Address | Oklahoma City, OK 73111-4520 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2013 |
Last Update Date | 15/08/2013 |