Healthcare Provider Details

I. General information

NPI: 1588761688
Provider Name (Legal Business Name): BRADLEY J HIGH LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 THOMAS JONES WAY STE 204
EXTON PA
19341-2553
US

IV. Provider business mailing address

1055 E BALTIMORE PIKE STE 300
MEDIA PA
19063-5173
US

V. Phone/Fax

Practice location:
  • Phone: 610-892-3800
  • Fax:
Mailing address:
  • Phone: 610-892-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC003942
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC003942
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: