Provider Demographics
NPI:1669024865
Name:STEWART, BRADLEY (LPC)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:STEWART
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 1:323 E GARFIELD RD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:OH
Mailing Address - Zip Code:44202-9417
Mailing Address - Country:US
Mailing Address - Phone:330-826-1122
Mailing Address - Fax:
Practice Address - Street 1:323 E GARFIELD RD STE 8
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:OH
Practice Address - Zip Code:44202-9417
Practice Address - Country:US
Practice Address - Phone:330-826-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1901582-TRNE101YM0800X
OHC.2103431101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health