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General NPI Number Information
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NPI Number | 1215461637
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Entity Type | Individual
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Provider Name | DUSTIN M BRALEY LCDC III, CT
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Gender | Male
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Dates
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Enumeration Date | 04/12/2017
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Last Update Date | 09/24/2025
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Provider Practice Location Address
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Address Line | 6140 S BROADWAY
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City | LORAIN
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State | OH
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Zip | 44053-3821
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Country | US
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Telephone | 440-233-7232
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Fax | 440-233-9070
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Provider Business Mailing Address
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Address Line | 6140 S BROADWAY
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City | LORAIN
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State | OH
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Zip | 44053-3821
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Country | US
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Telephone | 440-233-7232
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Fax | 440-233-9070
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | C.2506918-TRNE
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LCDCIII.162542
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License Number State | OH
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