Individual
MR. BRADEN ALEXANDER GIBBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
2325 S HARVARD AVE, TULSA, OK 74114-3300
(918) 712-4301
Mailing address
2325 S HARVARD AVE, TULSA, OK 74114-3300
(918) 712-4301
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
10011
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1477004315
DMH
OK
Enumeration date
10/15/2016
Last updated
04/29/2021
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