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NPI Code Detail

MEDICARE: MS. CHANDRA LAVELLE BRADFORD

MEDICARE:  MS. CHANDRA LAVELLE BRADFORD
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
1101Y00000XCounselor

General Provider Information

NPI Number : 1013285550
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CHANDRA LAVELLE BRADFORD
Provider Business Mailing Address
First Line : 3041 NW 33RD ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73112-6919
Country : US
Telephone Number : 405-948-6508
Fax Number :
Provider Business Practice Location Address
First Line : 3041 NW 33RD ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73112-6919
Country : US
Telephone Number : 405-948-6508
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/12/2011
Last Update Date : 12/12/2011

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Directions to “ MS. CHANDRA LAVELLE BRADFORD ” Practice Location

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