MEDICARE: BRAVELY, LLC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1669335485
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRAVELY, LLC

Provider Business Mailing Address
First Line	:	9726 E 42ND ST STE 143
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74146-3626
Country	:	US
Telephone Number	:	918-859-5033
Fax Number	:

Provider Business Practice Location Address
First Line	:	9726 E 42ND ST STE 143
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74146-3626
Country	:	US
Telephone Number	:	918-401-0480
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	VERONICA CLYBURN
Credential	:	LPC-S, NCC, RPT
Telephone Number	:	918-859-5033

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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Directions to “BRAVELY, LLC ” Practice Location

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