Provider Demographics
NPI:1033323696
Name:BAGLEY, PERRY BRAD (MS, QP, LMFT)
Entity Type:Individual
Prefix:MR
First Name:PERRY
Middle Name:BRAD
Last Name:BAGLEY
Suffix:
Gender:M
Credentials:MS, QP, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2313 EXECUTIVE CIR STE C
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-3744
Mailing Address - Country:US
Mailing Address - Phone:252-215-5716
Mailing Address - Fax:
Practice Address - Street 1:2313 EXECUTIVE CIR STE C
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3744
Practice Address - Country:US
Practice Address - Phone:252-215-5716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1275106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist