Provider Demographics
NPI:1780892125
Name:BRADY, SHARON SMITH (PHD)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:SMITH
Last Name:BRADY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 NW SHERIDAN RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-6521
Mailing Address - Country:US
Mailing Address - Phone:580-355-7474
Mailing Address - Fax:580-355-6765
Practice Address - Street 1:503 NW SHERIDAN RD
Practice Address - Street 2:SUITE A
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6521
Practice Address - Country:US
Practice Address - Phone:580-355-7474
Practice Address - Fax:580-355-6765
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK642103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist