Provider Demographics
NPI:1538491493
Name:BRADLEY, LETORIA (MS, IMH)
Entity Type:Individual
Prefix:
First Name:LETORIA
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:MS, IMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 S STERLING AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4524
Mailing Address - Country:US
Mailing Address - Phone:813-625-1569
Mailing Address - Fax:
Practice Address - Street 1:730 S STERLING AVE STE 301
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4524
Practice Address - Country:US
Practice Address - Phone:813-625-1569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH 6990101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health