Provider Demographics
NPI:1902249741
Name:HORN, BRADLEY (MS, LPC)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:
Last Name:HORN
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 N BROOKLINE AVE STE 360
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-3622
Mailing Address - Country:US
Mailing Address - Phone:405-565-0554
Mailing Address - Fax:
Practice Address - Street 1:5100 N BROOKLINE AVE STE 360
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-3622
Practice Address - Country:US
Practice Address - Phone:405-565-0554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-11
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1902249741Medicaid