Healthcare Provider Details

I. General information

NPI: 1902746464
Provider Name (Legal Business Name): CAMPBELL BRADLEY RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8440 HIGHWAY 51 S STE A
BRIGHTON TN
38011-8018
US

IV. Provider business mailing address

8440 HIGHWAY 51 S STE A
BRIGHTON TN
38011-8018
US

V. Phone/Fax

Practice location:
  • Phone: 901-290-3916
  • Fax: 901-347-3495
Mailing address:
  • Phone: 901-290-3916
  • Fax: 901-347-3495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-521861
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: