Provider Demographics
NPI:1508356882
Name:CHERRY, BRAD SCOTT (MS LPC/LPCC)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:SCOTT
Last Name:CHERRY
Suffix:
Gender:M
Credentials:MS LPC/LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2179 ENCHANTED BRIM DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79911-7503
Mailing Address - Country:US
Mailing Address - Phone:267-767-9768
Mailing Address - Fax:
Practice Address - Street 1:3860 TIERRA CAMPA DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-4372
Practice Address - Country:US
Practice Address - Phone:915-549-5197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-13
Last Update Date:2018-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79785101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional