Provider Demographics
NPI:1275979932
Name:BRADLEY COUNSELING CENTERS LICENSED CLINICAL SOCIAL WORKER CORPORATION
Entity Type:Organization
Organization Name:BRADLEY COUNSELING CENTERS LICENSED CLINICAL SOCIAL WORKER CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SALLIE
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:559-916-7585
Mailing Address - Street 1:PO BOX 27065
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-7065
Mailing Address - Country:US
Mailing Address - Phone:559-916-7585
Mailing Address - Fax:559-230-1799
Practice Address - Street 1:2519 W SHAW AVE
Practice Address - Street 2:SUITE #100
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3311
Practice Address - Country:US
Practice Address - Phone:559-230-1008
Practice Address - Fax:559-230-1799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-21
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALW112491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty