MEDICARE: BRADLEY WIMSATT MS, LPCC-S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	277258	KY

General Provider Information

NPI Number	:	1023449774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADLEY WIMSATT MS, LPCC-S

Provider Business Mailing Address
First Line	:	920 FREDERICA ST STE 308
Second Line	:
City	:	OWENSBORO
State	:	KY
Zip	:	42301-3078
Country	:	US
Telephone Number	:	270-702-4006
Fax Number	:

Provider Business Practice Location Address
First Line	:	920 FREDERICA ST STE 308
Second Line	:
City	:	OWENSBORO
State	:	KY
Zip	:	42301-3078
Country	:	US
Telephone Number	:	270-702-4006
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2013
Last Update Date	:	03/09/2026

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