Individual
MRS. GLENETTA LASCHELLE BRADLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
502 N 14TH ST, PERRY, OK 73077-5022
(918) 308-5512
(580) 215-5767
Mailing address
502 N 14TH ST, PERRY, OK 73077-5022
(918) 308-5512
(580) 215-5767
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
104100000X
Social Worker
7104
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7104
LCSW
OK
Enumeration date
11/28/2009
Last updated
03/14/2022
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