Healthcare Provider Details

I. General information

NPI: 1568958817
Provider Name (Legal Business Name): JENNIFER BRADLEY OR CHRYSALIS THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2018
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 DOUG BAKER BLVD STE 107-524
HOOVER AL
35242-4974
US

IV. Provider business mailing address

1401 DOUG BAKER BLVD STE 107524
HOOVER AL
35242-4974
US

V. Phone/Fax

Practice location:
  • Phone: 205-880-4742
  • Fax: 205-301-7356
Mailing address:
  • Phone: 205-880-4742
  • Fax: 205-301-7356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateAL

VIII. Authorized Official

Name: JENNIFER BRADLEY
Title or Position: OWNER
Credential: LPC
Phone: 205-677-8134