Healthcare Provider Details

I. General information

NPI: 1750186573
Provider Name (Legal Business Name): COLETTE ROYLYN CROSS BRADLEY SCHOOL COUNSELOR PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2025
Last Update Date: 02/17/2025
Certification Date: 02/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 S GOLD ST
YREKA CA
96097-3110
US

IV. Provider business mailing address

609 S GOLD ST
YREKA CA
96097-3110
US

V. Phone/Fax

Practice location:
  • Phone: 530-331-9706
  • Fax: 530-842-8436
Mailing address:
  • Phone: 530-331-9706
  • Fax: 530-842-8436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number24007750
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: