Healthcare Provider Details

I. General information

NPI: 1861916249
Provider Name (Legal Business Name): JORDAN BRACHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2017
Last Update Date: 05/16/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 S COLUMBIA AVE STE 580
TULSA OK
74114-3519
US

IV. Provider business mailing address

118 E 54TH PL
TULSA OK
74105-6730
US

V. Phone/Fax

Practice location:
  • Phone: 918-982-6524
  • Fax:
Mailing address:
  • Phone: 918-497-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7130
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: