Provider Demographics
NPI:1477687614
Name:BRADY & BRADY, P.C.
Entity Type:Organization
Organization Name:BRADY & BRADY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:O
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:580-355-7474
Mailing Address - Street 1:PO BOX 6446
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73506-0446
Mailing Address - Country:US
Mailing Address - Phone:580-355-7474
Mailing Address - Fax:580-355-6765
Practice Address - Street 1:6004 NW 157TH ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-8983
Practice Address - Country:US
Practice Address - Phone:580-355-7474
Practice Address - Fax:580-355-6765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK198103T00000X
OK642103T00000X
TX21363103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK731279230001OtherBCBS DOUGLAS BRADY
OK443560979001OtherBCBS SHARON BRADY
OK731279230001OtherBCBS DOUGLAS BRADY