Healthcare Provider Details

I. General information

NPI: 1740904978
Provider Name (Legal Business Name): PRECIOUS BRADLEY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PRECIOUS BRADLEY LPC

II. Dates (important events)

Enumeration Date: 09/30/2022
Last Update Date: 09/30/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

477 E BUTTERFIELD RD
LOMBARD IL
60148-5618
US

IV. Provider business mailing address

477 E BUTTERFIELD RD STE 212
LOMBARD IL
60148-4879
US

V. Phone/Fax

Practice location:
  • Phone: 630-866-5666
  • Fax:
Mailing address:
  • Phone: 630-866-5666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.018312
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: