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General NPI Number Information
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NPI Number | 1245109925
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Entity Type | Organization
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Legal Business Name | BRADLEY THERAPY AND WELLNESS
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Dates
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Enumeration Date | 11/01/2025
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Last Update Date | 11/01/2025
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Provider Practice Location Address
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Address Line | 15811 CENTRAL AVE UNIT 123
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City | OAK FOREST
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State | IL
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Zip | 60452-7606
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Country | US
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Telephone | 708-397-6614
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Fax |
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Provider Business Mailing Address
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Address Line | 15811 CENTRAL AVE UNIT 123
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City | OAK FOREST
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State | IL
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Zip | 60452-7606
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Country | US
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Telephone | 708-397-6614
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | MARY BRADLEY
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Credential | LCPC
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Telephone | 708-397-6614
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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