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NPI Code Detail

MEDICARE: MR. LAWRENCE WAYNE BRADY

MEDICARE: MR. LAWRENCE WAYNE BRADY
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
1101Y00000XCounselorOK

General Provider Information

NPI Number : 1689957342
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. LAWRENCE WAYNE BRADY
Provider Business Mailing Address
First Line : 1729 S BALTIMORE AVE
Second Line :
City : TULSA
State : OK
Zip : 74119-4807
Country : US
Telephone Number : 918-582-7305
Fax Number :
Provider Business Practice Location Address
First Line : 1729 S BALTIMORE AVE
Second Line :
City : TULSA
State : OK
Zip : 74119-4807
Country : US
Telephone Number : 918-582-7305
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2011
Last Update Date : 09/20/2011

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Directions to “ MR. LAWRENCE WAYNE BRADY ” Practice Location

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