Provider Demographics
NPI:1952707929
Name:BRADLEY, VANESSA (LADC-MH)
Entity type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:LADC-MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5305 S WESTERN AVE STE 524,
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-7701
Mailing Address - Country:US
Mailing Address - Phone:405-695-0240
Mailing Address - Fax:
Practice Address - Street 1:5305 S WESTERN AVE STE 524,
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-7701
Practice Address - Country:US
Practice Address - Phone:405-695-0240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-18
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1494101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)