Provider Demographics
NPI:1639813710
Name:FLETCHER, BRADLEE
Entity Type:Individual
Prefix:
First Name:BRADLEE
Middle Name:
Last Name:FLETCHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 GENTILLY BLVD # 225
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70126-4858
Mailing Address - Country:US
Mailing Address - Phone:601-316-8770
Mailing Address - Fax:
Practice Address - Street 1:3303 TULANE AVE STE 3
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-7185
Practice Address - Country:US
Practice Address - Phone:504-302-1323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-25
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
LA9003101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health