Healthcare Provider Details

I. General information

NPI: 1316473515
Provider Name (Legal Business Name): BRADLEY MCMORRIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2017
Last Update Date: 05/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 E THOMAS ST
HAMMOND LA
70401
US

IV. Provider business mailing address

19924 LA HWY 42
LIVINGSTON LA
70754
US

V. Phone/Fax

Practice location:
  • Phone: 985-956-7823
  • Fax:
Mailing address:
  • Phone: 225-328-0848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: