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NPI Code Detail

MEDICARE: MARTHA BRADLEY LMHC

MEDICARE: MARTHA BRADLEY LMHC
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
1101YM0800XMental Health CounselorAPC6784GA
2101YM0800XMental Health CounselorMH24395FL

General Provider Information

NPI Number : 1235780776
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARTHA BRADLEY LMHC
Provider Business Mailing Address
First Line : 150 MAGNOLIA AVE
Second Line :
City : DAYTONA BEACH
State : FL
Zip : 32114-4304
Country : US
Telephone Number : 386-236-3225
Fax Number :
Provider Business Practice Location Address
First Line : 301 JUSTICE LN
Second Line :
City : BUNNELL
State : FL
Zip : 32110-4487
Country : US
Telephone Number : 800-539-4228
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2019
Last Update Date : 11/08/2024

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