MEDICARE: MELISSA LOUISE 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	101YP2500X	Professional Counselor	P2001007	AR
2	101YM0800X	Mental Health Counselor	P2001007	AR

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	:	1518113463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA LOUISE BRADLEY LPC

Provider Business Mailing Address
First Line	:	PO BOX 414
Second Line	:
City	:	GREENBRIER
State	:	AR
Zip	:	72058-0414
Country	:	US
Telephone Number	:	501-679-0232
Fax Number	:

Provider Business Practice Location Address
First Line	:	1310 W MAIN ST STE 100
Second Line	:
City	:	RUSSELLVILLE
State	:	AR
Zip	:	72801-2803
Country	:	US
Telephone Number	:	479-964-2011
Fax Number	:	479-964-2008

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

Provider Enumeration Date	:	08/12/2008
Last Update Date	:	12/12/2025

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