Active NPI
Brad T Brogdon, LPC
- Professional Counselor
- Ardmore, OK
National Provider Identifier
1174862320
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 6840
- Practice address
- 2007 N Commerce St
Ardmore, OK 73401-1268 - Phone
- (580) 223-5636
- NPI assigned
- Feb 7, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 6840 | OK | Primary |
Addresses
Primary practice location
2007 N Commerce St
Ardmore, OK 73401-1268
Mailing address
2706 E Harbert Rd
Tishomingo, OK 73460-4035
Phone (580) 310-8105
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6840 | OK | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Valor Wellness, LLC | Professional | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Professional Counselor
- Tishomingo, OK
- NPI 1982420188
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1360195200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1734652800000",
"number": "1174862320",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2706 E HARBERT RD",
"city": "TISHOMINGO",
"state": "OK",
"postal_code": "734604035",
"telephone_number": "580-310-8105"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2007 N COMMERCE ST",
"city": "ARDMORE",
"state": "OK",
"postal_code": "734011268",
"telephone_number": "580-223-5636"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROGDON",
"first_name": "BRAD",
"middle_name": "T",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-02-07",
"last_updated": "2024-12-20",
"certification_date": "2024-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OK",
"license": "6840",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ardmore, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.