Healthcare Provider Details

I. General information

NPI: 1134731540
Provider Name (Legal Business Name): BRADLEY QUERTERMOUS QUERTERMOUS BS, CMHP, QMHP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 08/18/2020
Certification Date: 08/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

G3169 BEECHER RD
FLINT MI
48532-3611
US

IV. Provider business mailing address

PO BOX 289
MASON MI
48854-0289
US

V. Phone/Fax

Practice location:
  • Phone: 810-237-0799
  • Fax:
Mailing address:
  • Phone: 517-676-5405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: