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General NPI Number Information
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NPI Number | 1689352833
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Entity Type | Organization
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Legal Business Name | IRIS K BRADLEY
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Dates
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Enumeration Date | 07/07/2023
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Last Update Date | 07/07/2023
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Provider Practice Location Address
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Address Line | 12 W WENGER RD
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City | ENGLEWOOD
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State | OH
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Zip | 45322-2754
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Country | US
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Telephone | 254-226-0228
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Fax |
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Provider Business Mailing Address
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Address Line | 7100 SALEM CROSSING PL
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City | ENGLEWOOD
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State | OH
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Zip | 45322-2568
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Country | US
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Telephone | 254-226-0228
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MS. IRIS K BRADLEY
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Credential | LICDC
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Telephone | 254-226-0228
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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 |
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License Number State |
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