Provider Demographics
NPI:1346649761
Name:BRADY, LEAH (MSW)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:BRADY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 177
Mailing Address - Street 2:
Mailing Address - City:SEILING
Mailing Address - State:OK
Mailing Address - Zip Code:73663-0177
Mailing Address - Country:US
Mailing Address - Phone:580-922-5656
Mailing Address - Fax:580-922-3261
Practice Address - Street 1:1116 19TH ST
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-2925
Practice Address - Country:US
Practice Address - Phone:580-922-5656
Practice Address - Fax:580-922-3261
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-21
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK59011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical