Doctor Name: | TANYA R BRADY |
NPI Number: | 1144439373 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | B.A. |
License Number: | |
Business Practice Address: | 120 W 1st St Watonga, OK - 737723643 |
Business Phone Number: | 5806232545 |
Business Fax Number: | 5806232668 |
Mailing Address: | 120 W 1st St, Po Box 569 WATONGA |
State: | OK |
Postal Code: | 737723643 |
Phone Number: | 5806232545 |
Fax Number: | 5806232668 |
NPI Enumeration Date: | 05/22/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |