Provider Demographics
NPI:1235994252
Name:BRADLEY, ELIZABETH-LEIGH (LMFT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH-LEIGH
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 S LEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4921
Mailing Address - Country:US
Mailing Address - Phone:860-729-9042
Mailing Address - Fax:
Practice Address - Street 1:1625 S LEWIS AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4921
Practice Address - Country:US
Practice Address - Phone:860-729-9042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001195106H00000X
171400000X
OK11641106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171400000XOther Service ProvidersHealth & Wellness Coach