Premadonna Braddick, MA, LPC

Primary specialty

CounselorTaxonomy code 101Y00000X

Practice address

5424 North Madison Ave
Tulsa, OK 74126

Phone

(918) 892-1797

NPI assigned

May 31, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Improving Lives Counseling Services IncGroup PAC ID 3870818230, 32 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

Practice roles

Locations

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.

• Improving Lives Counseling Services, Inc.

  • Community/Behavioral Health Agency
  • Tulsa, OK
  • NPI 1487967444
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1180569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689638400000",
    "number": "1518168939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8086 S YALE AVE # 236",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741369003",
            "telephone_number": "918-892-1797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5424 NORTH MADISON AVE",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "74126",
            "telephone_number": "918-892-1797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADDICK",
        "first_name": "PREMADONNA",
        "name_prefix": "Mrs.",
        "credential": "MA, LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-31",
        "last_updated": "2023-07-18",
        "certification_date": "2023-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jordan Bracht
• Travis John Brachtenbach, DO
• Tamara Deann Brackett-Bryant, B.A. CASE MANAGER
• Ranelle Monterry Bracy-Lewis, D.O.
• Derrick Adrian Braddick
• Braden Partners LP (Pacific Pulmonary Services)
• Carla M Bradford, MS
• Mary L Bradford, LCSW
• Summer Dawn Bradford
• Terry Bradford

• Counselor in Tulsa, OK
• Providers in Tulsa, OK by specialty
• Counselor in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.