Individual
BRADLEY WOUTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1728 S CARSON AVE, TULSA, OK 74119-4610
(918) 406-3420
Mailing address
11680 S 153RD WEST AVE, SAPULPA, OK 74066-8564
(918) 512-6273
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
05/04/2023
Last updated
02/15/2025
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