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Ezrikai Broam

Social Worker

Behavioral Health & Social Service Providers

6216 S Lewis Ave Ste 180, Tulsa, OK 74136-1077

PECOS Enrollment

This provider is enrolled in PECOS as LISA WEICHE.

Based on the most recent information from CMS, provider Ezrikai Broam is legally eligible to order and refer claims for Part B and DME services only.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records today at 11:47 AM.

Profile Details

Provider ID
1093951709
Provider Type
Individual
Full Name
Broam, Ezrikai
Title
Ms.
Credential
LCSW, LADC

Gender
Female
Sole Proprietor
No
Enumeration Date
12/30/2008
Last Updated
3/26/2024

Contact Information

Practice Location

6216 S Lewis Ave Ste 180, Tulsa, OK 74136-1077

(918) 960-7852

(539) 664-5738

Mailing Location

6216 S Lewis Ave Ste 180, Tulsa, OK 74136-1077

(918) 960-7852

(396) 645-7385

Provider Taxonomies

Code	Description	License
Code 1041C0700X Primary	Description Social Worker Behavioral Health & Social Service Providers	License 3928 Oklahoma
Code 101YA0400X	Description Counselor Behavioral Health & Social Service Providers	License 1039 Oklahoma

Ezrikai Broam

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

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Nikel, Jeremy Craig

Greenfield, Wilma Louise

Avery, Zachary Hamilton

Sutton-Lipsey, Tamika

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Brizendine, April Lynn