Healthcare Provider Details

I. General information

NPI: 1669335485
Provider Name (Legal Business Name): BRAVELY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9726 E 42ND ST STE 143
TULSA OK
74146-3626
US

IV. Provider business mailing address

9726 E 42ND ST STE 143
TULSA OK
74146-3626
US

V. Phone/Fax

Practice location:
  • Phone: 918-401-0480
  • Fax:
Mailing address:
  • Phone: 918-859-5033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: VERONICA CLYBURN
Title or Position: OWNER
Credential: LPC-S, NCC, RPT
Phone: 918-859-5033