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NPI Code Detail

MEDICARE: LETORIA BRADLEY M.S., IMH

MEDICARE:   LETORIA  BRADLEY  M.S., IMH
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
1101YM0800XMental Health CounselorIMH 6990FL

General Provider Information

NPI Number : 1538491493
Entity Type Code : Individual
Provider Name (Legal Business Name) : LETORIA BRADLEY M.S., IMH
Provider Business Mailing Address
First Line : 730 S STERLING AVE STE 301
Second Line :
City : TAMPA
State : FL
Zip : 33609-4524
Country : US
Telephone Number : 813-625-1569
Fax Number :
Provider Business Practice Location Address
First Line : 730 S STERLING AVE STE 301
Second Line :
City : TAMPA
State : FL
Zip : 33609-4524
Country : US
Telephone Number : 813-625-1569
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2010
Last Update Date : 02/03/2010

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Directions to “ LETORIA BRADLEY M.S., IMH” Practice Location

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