Provider Demographics
NPI:1174862320
Name:BROGDON, BRAD T (LPC)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:T
Last Name:BROGDON
Suffix:
Gender:M
Credentials:LPC
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Mailing Address - Street 1:RESOURCE MANAGEMENT
Mailing Address - Street 2:1300 HOPPE BLVD., SUITE 1
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820
Mailing Address - Country:US
Mailing Address - Phone:580-436-7211
Mailing Address - Fax:580-272-5757
Practice Address - Street 1:610 E 24TH ST
Practice Address - Street 2:
Practice Address - City:TISHOMINGO
Practice Address - State:OK
Practice Address - Zip Code:73460-3245
Practice Address - Country:US
Practice Address - Phone:580-371-2343
Practice Address - Fax:580-371-3614
Is Sole Proprietor?:No
Enumeration Date:2013-02-07
Last Update Date:2019-08-07
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor