Healthcare Provider Details

I. General information

NPI: 1982420188
Provider Name (Legal Business Name): VALOR WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2024
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2706 E HARBERT RD
TISHOMINGO OK
73460-4035
US

IV. Provider business mailing address

2706 E HARBERT RD
TISHOMINGO OK
73460-4035
US

V. Phone/Fax

Practice location:
  • Phone: 580-310-8105
  • Fax:
Mailing address:
  • Phone: 580-310-8105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: BRAD THOMAS BROGDON
Title or Position: LICENSED PROFESSION COUNSELOR/CEO
Credential: LPC
Phone: 580-310-8105