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General NPI Number Information
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NPI Number | 1568674125
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Entity Type | Individual
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Provider Name | CHARLES E. BRADLEY III L.P.C., L.M.F.T.
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Gender | Male
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 135 CROYDON AVE SUITE A
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City | BATON ROUGE
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State | LA
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Zip | 70806-4502
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Country | US
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Telephone | 225-928-8557
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Fax | 225-928-8923
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Provider Business Mailing Address
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Address Line | 135 CROYDON AVE SUITE A
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City | BATON ROUGE
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State | LA
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Zip | 70806-4502
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Country | US
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Telephone | 225-928-8557
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Fax | 225-928-8923
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1999
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License Number State | LA
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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 | 11544
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT 44
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License Number State | LA
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 2707
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License Number State | TX
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