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General NPI Number Information
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NPI Number | 1013736438
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Entity Type | Organization
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Legal Business Name | BRADLEY RECOVERY CENTER
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Dates
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Enumeration Date | 10/03/2024
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Last Update Date | 07/09/2025
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Provider Practice Location Address
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Address Line | 10400 DIXIE HWY STE 103
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City | LOUISVILLE
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State | KY
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Zip | 40272-5913
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Country | US
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Telephone | 502-409-4013
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Fax |
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Provider Business Mailing Address
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Address Line | 10400 DIXIE HWY STE 103
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City | LOUISVILLE
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State | KY
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Zip | 40272-5913
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Country | US
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Telephone | 502-409-4013
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. MICHAEL PICKETT
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Credential |
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Telephone | 859-619-5659
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 364SA2100X
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Taxonomy Name | Acute Care Clinical Nurse Specialist
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 2083A0300X
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Taxonomy Name | Addiction Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #12
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #13
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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