Healthcare Provider Details

I. General information

NPI: 1578997060
Provider Name (Legal Business Name): BRADLEY R HOLT MA, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2013
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 KING OF PRUSSIA RD
RADNOR PA
19087-4521
US

IV. Provider business mailing address

680 AMERICAN AVE SUITE 302
KING OF PRUSSIA PA
19406-4023
US

V. Phone/Fax

Practice location:
  • Phone: 610-644-6464
  • Fax: 610-981-6078
Mailing address:
  • Phone: 610-644-6464
  • Fax: 610-981-6078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC008645
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180017377
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: