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NPI Code Detail

MEDICARE: MS. EZRIKAI BROAM LCSW, LADC

MEDICARE: MS. EZRIKAI BROAM LCSW, LADC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor1039OK
21041C0700XClinical Social Worker3928OK

General Provider Information

NPI Number : 1093951709
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. EZRIKAI BROAM LCSW, LADC
Provider Business Mailing Address
First Line : 6216 S LEWIS AVE STE 180
Second Line :
City : TULSA
State : OK
Zip : 74136-1077
Country : US
Telephone Number : 918-960-7852
Fax Number : 396-645-7385
Provider Business Practice Location Address
First Line : 6216 S LEWIS AVE STE 180
Second Line :
City : TULSA
State : OK
Zip : 74136-1077
Country : US
Telephone Number : 918-960-7852
Fax Number : 539-664-5738
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/30/2008
Last Update Date : 03/26/2024

Similar Medicare Providers

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Practice Location Address:
6216 S LEWIS AVE STE 180
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74136-1077
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Practice Fax:
1548368988 — MRS. JENNIFER LYNNE MATHIS-COLLEY L.P.C.
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1356670111 — BRITTANY RAEL GOMEZ LCSW
Practice Location Address:
6216 S LEWIS AVE STE 180
TULSA, OK
74136-1077
Practice Phone: 918-960-7852
Practice Fax: 539-664-5738
1760743496 — MARISSA JONES
Practice Location Address:
6216 S LEWIS AVE STE 180
TULSA, OK
74136-1077
Practice Phone: 918-960-7852
Practice Fax:
1477809754 — DEBORAH EDMONSON
Practice Location Address:
6216 S LEWIS AVE STE 180
TULSA, OK
74136-1077
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1942557335 — CRYSTAL ROSE HOFFMAN FAULKENBERRY LPC
Practice Location Address:
6216 S LEWIS AVE STE 180
TULSA, OK
74136-1077
Practice Phone: 918-960-7852
Practice Fax: 539-664-5738

Directions to “ MS. EZRIKAI BROAM LCSW, LADC” Practice Location

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