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NPI Code Detail

MEDICARE: BRADLEY HOLLEY LLPC

MEDICARE: BRADLEY HOLLEY LLPC
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 Counselor6401015306MI
2101YA0400XAddiction (Substance Use Disorder) Counselor6401017764MI

General Provider Information

NPI Number : 1982064002
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRADLEY HOLLEY LLPC
Provider Business Mailing Address
First Line : 863 N PINE RD STE A
Second Line :
City : ESSEXVILLE
State : MI
Zip : 48732-2159
Country : US
Telephone Number : 989-928-3566
Fax Number : 989-391-9596
Provider Business Practice Location Address
First Line : 1480 N M 52 STE 1
Second Line :
City : OWOSSO
State : MI
Zip : 48867-1025
Country : US
Telephone Number : 989-723-8239
Fax Number : 989-391-9596
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2016
Last Update Date : 04/19/2021

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Directions to “ BRADLEY HOLLEY LLPC” Practice Location

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