MEDICARE: MRS. SHELBI BRADLEY LPC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1083103840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHELBI BRADLEY LPC

Provider Business Mailing Address
First Line	:	1604 42ND AVE
Second Line	:
City	:	GULFPORT
State	:	MS
Zip	:	39501-3832
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1989 PASS RD
Second Line	:
City	:	BILOXI
State	:	MS
Zip	:	39531-4103
Country	:	US
Telephone Number	:	228-207-1248
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2018
Last Update Date	:	08/11/2022

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