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NPI Code Detail

MEDICARE: MS. EILEEN BRADYCHOK MA, LPC, LBSW

MEDICARE: MS. EILEEN BRADYCHOK MA, LPC, LBSW
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
1101YP2500XProfessional Counselor6401001728MI

General Provider Information

NPI Number : 1598806432
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. EILEEN BRADYCHOK MA, LPC, LBSW
Provider Business Mailing Address
First Line : FIRST RESOURCES AND TREATMENT NORTH
Second Line : 43740 GROESBECK
City : CLINTON TOWNSHIP
State : MI
Zip : 48036-5505
Country : US
Telephone Number : 586-469-7629
Fax Number : 586-466-4143
Provider Business Practice Location Address
First Line : 43740 N GROESBECK HWY
Second Line :
City : CLINTON TOWNSHIP
State : MI
Zip : 48036-1139
Country : US
Telephone Number : 586-469-7629
Fax Number : 586-466-4143
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/12/2007
Last Update Date : 07/08/2007

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