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General NPI Number Information
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NPI Number | 1932757721
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Entity Type | Organization
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Legal Business Name | BRADLEY COUNSELING & CONSULTING, LLC
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Dates
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Enumeration Date | 08/27/2019
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Last Update Date | 08/27/2019
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Provider Practice Location Address
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Address Line | 17900 DIXIE HWY STE 5
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City | HOMEWOOD
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State | IL
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Zip | 60430-3039
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Country | US
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Telephone | 708-289-2317
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Fax | 708-289-2317
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Provider Business Mailing Address
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Address Line | 17900 DIXIE HWY STE 5
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City | HOMEWOOD
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State | IL
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Zip | 60430-3039
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Country | US
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Telephone | 708-289-2317
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Fax | 708-289-2317
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Authorized Official
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Title or Position | CEO
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Name | PETER BRADLEY
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Credential | LCPC, CRADC
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Telephone | 708-289-2317
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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