| Doctor Name: | MISS TIERRA BRADDEN |
| NPI Number: | 1003249830 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 1578690137 |
| Business Practice Address: | 3621 N Kelley Ave Ste 100 Oklahoma City, OK - 731114520 |
| Business Phone Number: | 4055254425 |
| Business Fax Number: | |
| Mailing Address: | 5417 S Huddleston Dr, OKLAHOMA CITY |
| State: | OK |
| Postal Code: | 731352321 |
| Phone Number: | 4058386386 |
| Fax Number: | |
| NPI Enumeration Date: | 08/15/2013 |
| NPI Last Update Date: | 08/15/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 1578690137 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |