Individual
MS. TAHLIA LEIGH BRAGG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
123 E MAIN ST, OKLAHOMA CITY, OK 73104-2407
(405) 555-1234
Mailing address
6400 NW EXPRESSWAY APT 635, OKLAHOMA CITY, OK 73132-5135
(480) 720-1629
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
7342
OK
103T00000X
Psychologist
Primary
—
—
Other
Enumeration date
04/06/2016
Last updated
08/20/2021
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