Provider Demographics
NPI:1578974341
Name:BRADLEY, KAYLIE
Entity Type:Individual
Prefix:
First Name:KAYLIE
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9710 S 78TH EAST AVE
Mailing Address - Street 2:APT 10105
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-6951
Mailing Address - Country:US
Mailing Address - Phone:405-314-4766
Mailing Address - Fax:
Practice Address - Street 1:4845 S SHERIDAN RD
Practice Address - Street 2:SUITE 510
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-5751
Practice Address - Country:US
Practice Address - Phone:918-384-0002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health