Provider Demographics
NPI:1528543162
Name:AARON, BRADLEY KYLE (LPC)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:KYLE
Last Name:AARON
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 1:762 WATERTON CT
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70819-3353
Mailing Address - Country:US
Mailing Address - Phone:225-802-2896
Mailing Address - Fax:
Practice Address - Street 1:150 CORA DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-4201
Practice Address - Country:US
Practice Address - Phone:225-802-2896
Practice Address - Fax:225-343-5300
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-29
Last Update Date:2018-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5915101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LANONEOtherNO INSURANCE CURRENTLY