MEDICARE: MS. MARGARET ANN GRADY LPC, LADC, LMT, BCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	0114391	NM
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	0105881	NM
3	101YP2500X	Professional Counselor	4468	OK
4	101YA0400X	Addiction (Substance Use Disorder) Counselor	899	OK

General Provider Information

NPI Number	:	1245395011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARGARET ANN GRADY LPC, LADC, LMT, BCPC

Provider Business Mailing Address
First Line	:	5131 N CLASSEN BLVD
Second Line	:	STE. 208
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-5258
Country	:	US
Telephone Number	:	405-896-3808
Fax Number	:	405-242-4105

Provider Business Practice Location Address
First Line	:	5131 N CLASSEN BLVD
Second Line	:	STE. 208
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-5258
Country	:	US
Telephone Number	:	405-896-3808
Fax Number	:	405-242-4105

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2006
Last Update Date	:	01/02/2014

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