MEDICARE: NAOMI BRADLEY

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	103K00000X	Behavior Analyst	T082183107	OK
2	101YM0800X	Mental Health Counselor	6784	OK

General Provider Information

NPI Number	:	1548528318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAOMI BRADLEY

Provider Business Mailing Address
First Line	:	13132 SW 44TH ST
Second Line	:
City	:	YUKON
State	:	OK
Zip	:	73099-7250
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 N MUSTANG RD STE C
Second Line	:
City	:	MUSTANG
State	:	OK
Zip	:	73064-7044
Country	:	US
Telephone Number	:	405-301-3509
Fax Number	:

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

Provider Enumeration Date	:	04/30/2012
Last Update Date	:	08/06/2025

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Directions to “ NAOMI BRADLEY ” Practice Location

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