Provider Demographics
NPI:1154671972
Name:BRADLEY, KYRA KAMILLE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:KYRA
Middle Name:KAMILLE
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:KYRA
Other - Middle Name:KAMILLE
Other - Last Name:BRADLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8984 DARROW RD STE 2-167
Mailing Address - Street 2:
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087-2186
Mailing Address - Country:US
Mailing Address - Phone:330-265-3194
Mailing Address - Fax:
Practice Address - Street 1:3176 BLUE JAYE LN
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-3347
Practice Address - Country:US
Practice Address - Phone:234-738-1421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401019513101YP2500X
MI6401011094101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional