MEDICARE: MRS. PREMADONNA BRADDICK MA, LPC

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
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1518168939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PREMADONNA BRADDICK MA, LPC

Provider Business Mailing Address
First Line	:	8086 S YALE AVE # 236
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-9003
Country	:	US
Telephone Number	:	918-892-1797
Fax Number	:

Provider Business Practice Location Address
First Line	:	5424 NORTH MADISON AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74126
Country	:	US
Telephone Number	:	918-892-1797
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	07/18/2023

Similar Medicare Providers

1023969672 — YOLANDA RENEE PLATT
Practice Location Address:

5708 N GARRISON PL
TULSA, OK
74126-2206

Practice Phone: 918-961-2810
Practice Fax:

1821162702 — DR. THOMAS GENTRY WILLIAMS DDS
Practice Location Address:

4618 N FRANKFORT AVE
TULSA, OK
74126-3217

Practice Phone: 918-425-1376
Practice Fax:

1265575609 — STACY LACKEY M.S.
Practice Location Address:

5635 N MARTIN LUTHER KING JR BLVD
TULSA, OK
74126-6409

Practice Phone: 918-594-4731
Practice Fax: 918-595-4269

1689852667 — THOMAS G.WILLIAMS, INC,P.C
Practice Location Address:

4618 N FRANKFORT AVE
TULSA, OK
74126-3217

Practice Phone: 918-425-1376
Practice Fax: 918-425-1370

1184855389 — CAROLINE POWELL COUSSENS RN,ACNS-BC
Practice Location Address:

200 W 46TH ST N , DREAM CENTER
TULSA, OK
74126-6675

Practice Phone: 918-430-9984
Practice Fax: 918-430-1013

1972826659 — HOLLY E BENNETT APRN, FNP-C
Practice Location Address:

5635 N MLK JR BLVD
TULSA, OK
74126-6409

Practice Phone: 918-398-9460
Practice Fax: 918-992-2822

Directions to “ MRS. PREMADONNA BRADDICK MA, LPC” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.