Provider Demographics
NPI:1215121447
Name:BRAMLETT, LEAH DANIELLE (BA)
Entity type:Individual
Prefix:MS
First Name:LEAH
Middle Name:DANIELLE
Last Name:BRAMLETT
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 S HAMMACK AVE
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:OK
Mailing Address - Zip Code:73098-2220
Mailing Address - Country:US
Mailing Address - Phone:405-665-2102
Mailing Address - Fax:
Practice Address - Street 1:2530 S. COMMERCE
Practice Address - Street 2:BLDG. B
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73402
Practice Address - Country:US
Practice Address - Phone:580-223-5636
Practice Address - Fax:580-226-6727
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health