Provider Demographics
NPI:1225729023
Name:BRADLEY, DONALD (LPC)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3610 BROOK ST
Mailing Address - Street 2:
Mailing Address - City:IOWA COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:77583-1779
Mailing Address - Country:US
Mailing Address - Phone:248-672-7510
Mailing Address - Fax:
Practice Address - Street 1:3610 BROOK ST
Practice Address - Street 2:
Practice Address - City:IOWA COLONY
Practice Address - State:TX
Practice Address - Zip Code:77583-1779
Practice Address - Country:US
Practice Address - Phone:248-672-7510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87189101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional