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General NPI Number Information
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NPI Number | 1528576766
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Entity Type | Individual
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Provider Name | RANDALL LEE BRADLEY LPCC, LCDCIII
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Gender | Male
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Dates
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Enumeration Date | 01/22/2018
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Last Update Date | 06/04/2018
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Provider Practice Location Address
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Address Line | 2845 BELL ST
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City | ZANESVILLE
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State | OH
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Zip | 43701
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Country | US
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Telephone | 740-454-9766
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Fax | 740-588-6452
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Provider Business Mailing Address
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Address Line | 2845 BELL ST
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City | ZANESVILLE
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State | OH
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Zip | 43701-1720
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Country | US
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Telephone | 740-454-9766
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Fax | 740-588-6452
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 081186
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | C.0701120
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | E.1800711
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License Number State | OH
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