MEDICARE: BRADKE COUNSELING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	2005025550	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043707847
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRADKE COUNSELING, LLC

Provider Business Mailing Address
First Line	:	2451 EXECUTIVE DR STE 205
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63303-5606
Country	:	US
Telephone Number	:	314-477-6105
Fax Number	:

Provider Business Practice Location Address
First Line	:	2451 EXECUTIVE DR STE 205
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63303-5606
Country	:	US
Telephone Number	:	314-477-6105
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MACKENZIE L. LESTER
Credential	:	LCSW
Telephone Number	:	314-375-6599

Provider Enumeration Date	:	04/17/2018
Last Update Date	:	04/28/2025

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