Provider Demographics
NPI:1568674125
Name:BRADLEY, CHARLES E III (LPC, LMFT)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:E
Last Name:BRADLEY
Suffix:III
Gender:M
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 CROYDON AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-4502
Mailing Address - Country:US
Mailing Address - Phone:225-928-8557
Mailing Address - Fax:225-928-8923
Practice Address - Street 1:135 CROYDON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-4502
Practice Address - Country:US
Practice Address - Phone:225-928-8557
Practice Address - Fax:225-928-8923
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1999101YP2500X
TX11544101YP2500X
LAMFT 44106H00000X
TX2707106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist