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General NPI Number Information
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NPI Number | 1669335485
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Entity Type | Organization
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Legal Business Name | BRAVELY, LLC
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Dates
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Enumeration Date | 12/08/2025
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 9726 E 42ND ST STE 143
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City | TULSA
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State | OK
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Zip | 74146-3626
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Country | US
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Telephone | 918-401-0480
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Fax |
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Provider Business Mailing Address
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Address Line | 9726 E 42ND ST STE 143
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City | TULSA
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State | OK
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Zip | 74146-3626
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Country | US
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Telephone | 918-859-5033
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | VERONICA CLYBURN
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Credential | LPC-S, NCC, RPT
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Telephone | 918-859-5033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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