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NPI Code Detail

MEDICARE: DR. KELLY E BRADLEY PSYD

MEDICARE: DR. KELLY E BRADLEY PSYD
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 Counselor
2103TC0700XClinical Psychologist20043645AIN
3103TB0200XCognitive & Behavioral Psychologist20043645AIN

General Provider Information

NPI Number : 1578963187
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KELLY E BRADLEY PSYD
Provider Business Mailing Address
First Line : 250 N SHADELAND AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46219-4959
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6640 INTECH BLVD STE 195
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46278-2014
Country : US
Telephone Number : 317-295-0608
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/02/2014
Last Update Date : 01/11/2023

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Directions to “ DR. KELLY E BRADLEY PSYD” Practice Location

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