Provider Demographics
NPI:1033157847
Name:BRADLEY, TERRY DENISE (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:TERRY
Middle Name:DENISE
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2431 W MAIN ST
Mailing Address - Street 2:SUITE 603
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-1217
Mailing Address - Country:US
Mailing Address - Phone:334-673-8869
Mailing Address - Fax:334-673-8851
Practice Address - Street 1:2431 W MAIN ST
Practice Address - Street 2:SUITE 603
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-1217
Practice Address - Country:US
Practice Address - Phone:334-673-8869
Practice Address - Fax:334-673-8851
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1784101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-34689OtherBCBS OF AL