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General NPI Number Information
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NPI Number | 1043707847
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Entity Type | Organization
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Legal Business Name | BRADKE COUNSELING, LLC
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Dates
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Enumeration Date | 04/17/2018
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Last Update Date | 04/28/2025
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Provider Practice Location Address
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Address Line | 2451 EXECUTIVE DR STE 205
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City | SAINT CHARLES
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State | MO
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Zip | 63303-5606
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Country | US
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Telephone | 314-477-6105
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Fax |
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Provider Business Mailing Address
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Address Line | 2451 EXECUTIVE DR STE 205
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City | SAINT CHARLES
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State | MO
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Zip | 63303-5606
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Country | US
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Telephone | 314-477-6105
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MACKENZIE L. LESTER
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Credential | LCSW
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Telephone | 314-375-6599
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2005025550
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License Number State | MO
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