Individual
MRS. PREMADONNA BRADDICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LPC
Contact information
Practice address
5424 NORTH MADISON AVE, TULSA, OK 74126
(918) 892-1797
Mailing address
8086 S YALE AVE # 236, TULSA, OK 74136-9003
(918) 892-1797
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
05/31/2007
Last updated
07/18/2023
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